Three-dimensional non-coplanar conformal radiotherapy yields better results than traditional beam arrangements for adjuvant treatment of gastric cancer.

PURPOSE: The current standard of adjuvant treatment for gastric cancer after curative resection is concurrent administration of radiotherapy and 5-fluorouracil-based chemotherapy. The radiation fields are often arranged as anterioposterior-posteroanterior opposed parallel fields with general recommendations for sparing at least two-thirds of one kidney. We investigated whether a better radiation distribution would be achievable with three-dimensional conformal approaches compared with the classic anterioposterior-posteroanterior fields. METHODS AND MATERIALS: A total of 19 patients with adenocarcinoma of the stomach were treated with adjuvant chemoradiotherapy using a non-coplanar four-field arrangement. In each case, parallel planning using an anterioposterior-posteroanterior arrangement and a four-field "box" was performed, and the generated plans were subsequently compared for coverage of target volumes and doses to irradiated organs next to the tumor bed. A separate analysis was performed for kidneys exposed to greater and lower doses in each patient. The mean radiation dose and percentage of kidney volume receiving a dose >20 Gy were registered. Statistical analysis was performed using the two-tailed t test. RESULTS: The clinical target volume was adequately covered in all three plans. In the greater-dose kidney group, all the differences were statistically significant with a benefit for the three-dimensional plan. In the lower-dose kidney group, the differences in the mean radiation dose did not reach the level of statistical significance, and the differences in the kidney volume receiving a dose >20 Gy showed a statistically significant benefit for the three-dimensional plan. CONCLUSION: Non-coplanar three-dimensional-based conformal planning for postoperative radiotherapy for gastric cancer provided the best results regarding kidney and spinal cord exposure with adequate clinical target volume coverage. This technique was readily implemented in clinical practice.

[Brachytherapy combined with external beam radiation in localized prostate cancer].

BACKGROUND & RATIONALE: A combination of brachytherapy with external beam radiotherapy is one treatment option for localized moderately to poorly differentiated prostate cancer. This article presents initial Israeli experience with this treatment option. METHODS: In the last 6 years, 56 men were treated with a combination of internal brachytherapy, external beam radiation and 6 months adjuvant hormonotherapy. All were prospectively followed while using validated questionnaires to assess urinary morbidity and sexual function. RESULTS: Treatment was well tolerated by all. None had grade 2-3 rectal morbidity. Mild to moderate urinary morbidity was seen in most, not different than seen in radiation therapy when given as monotherapy. Sexual function was only mildly affected. Biochemical NED (PSA based) rates albeit for a rather short follow-up period, were similar to those seen when utilizing other radical treatment options. CONCLUSIONS: Combining I125-brachytherapy with external beam radiation together with a short course of hormonotherapy results in acceptable morbidity and good biochemical outcome. This option should be offered to selected patients with higher grade localized prostate cancer, when other options are less optimal.