Journal article
Extended field intensity modulated radiation therapy for gynecologic cancers: Is the risk of duodenal toxicity high?
Practical Radiation Oncology, v 5(4), pp E291-E297
01 Jul 2015
PMID: 25532491
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose: There have been conflicting reports regarding the incidence of duodenal toxicity in patients receiving intensity modulated radiation therapy (IMRT) with an extended field covering the para-aortic (PA) lymph nodes for gynecologic cancers. We reviewed our experiences and rates of duodenal toxicity in patients treated with extended field IMRT.
Methods and materials: Patients with either cervical or endometrial cancer who were treated with IMRT to the PA nodes for involved lymph nodes or for prophylactic intent between 2005 and 2013 were included. For prophylactic intent, the radiation dose to the PA nodes was 45 Gy in 25 fractions. For involved lymph nodes, a boost was delivered to the gross disease with a 0.7-cm expansion, with editing for critical structures. The entire duodenum was retrospectively contoured on all patients from the gastric outlet to the jejunal transition.
Results: We identified 76 eligible patients with endometrial and cervical cancer. The PA region was treated prophylactically in 46.1% (n = 35) and for involved PA lymph nodes in 53.9% (n = 41). The duodenum was contoured on all patients with a median volume of 83.2 cm(3) (range, 21.2-174.9 cm(3)). The mean volume of duodenum receiving 55 Gy (V-55) for those treated prophylactically and for involved PAnodes was 0 cm(3) and 0.8 cm(3) (range, 0-10.6 cm(3)), respectively (P = .014). Specifically, no patient had a V-55 >15 cm(3). The mean V-40 was 28.3 cm(3) (range, 0-77.3 cm(3)) and 41.4 (range, 0-90.0 cm(3)), respectively (P = .016). The mean dose delivered to 2 cm(3) of the duodenum was 34.9 Gy (range, 0-52.3 Gy) and 50.1 Gy (range, 31.3-58.3 Gy), respectively. Grade 3 acute gastrointestinal toxicity was recorded in 3.9% (n = 3) of patients.
Conclusions: In our experience, the treatment of PA lymph nodes using an IMRT technique is associated with a low duodenal toxicity profile and there has been no high-grade late duodenal toxicity. (C) 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
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Details
- Title
- Extended field intensity modulated radiation therapy for gynecologic cancers: Is the risk of duodenal toxicity high?
- Creators
- Karen M. Xu - UPMC Hillman Cancer CenterMalolan S. Rajagopalan - UPMC Hillman Cancer CenterHayeon Kim - UPMC Hillman Cancer CenterSushil Beriwal - UPMC Hillman Cancer Center
- Publication Details
- Practical Radiation Oncology, v 5(4), pp E291-E297
- Publisher
- Elsevier
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000422357700004
- Scopus ID
- 2-s2.0-84937162926
- Other Identifier
- 991021897283604721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging