Protection of organs at risk during neoadjuvant chemoradiotherapy for gastric cancer based on a comparison between conformal and intensity-modulated radiation therapy

Abstract

The aim of the present study was to compare the techniques of dynamic intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) in patients with gastric cancer. Implementation of the IMRT technique does not significantly affect the minimum and maximum dose levels in the planning target volume (PTV), but more effectively protects the critical organs. The study group consisted of 25 patients. The results of the analysis of the conformity index (CI) and the homogeneity index (HI) showed that the doses in the PTV regions were at a comparable level. The CI for the PTV was 0.95 for the 2-field technique, 0.95 for the 3-field technique, 0.96 for the 4-field technique and 0.94 for the IMRT technique. The CIs for these techniques for the clinical target volume (CTV) were 0.96, 0.96, 0.97 and 0.96, respectively, and the CIs for the gross tumor volume (GTV) were 0.99, 0.99, 0.99 and 0.98, respectively. The HI values for the PTV were 1.12 for the 2-field technique, 1.12 for the 3-field technique, 1.09 for the 4-field technique and 1.09 for the IMRT technique, and the HI values for the CTV were 1.12, 1.12, 1.09 and 1.08 for the same techniques, respectively. The HI values for the GTV were 1.09, 1.09, 1.07 and 1.06, respectively, which indicated significantly superior performance in the regions of healthy tissue. Statistical study was based on Friedman's rank analysis of variance to determine the level of reliability of the tested groups of variables (P<0.001). The present study demonstrated that the IMRT technique in the pre-operative radiotherapy of gastric cancer patients results in superior treatment tolerance and reduces the risk of damage to healthy tissue that is in close proximity to the irradiated area.