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Radiation Oncology
Published in: Radiation Oncology 1/2019

Open Access 01-12-2019 | Subtotal Gastrectomy | Review

Efficacy and safety of intensity-modulated radiation therapy versus three-dimensional conformal radiation treatment for patients with gastric cancer: a systematic review and meta-analysis

Authors: Fang Ren, Shaodan Li, Yin Zhang, Zhifei Zhao, Haiming Wang, Yixin Cui, Maoyun Wang

Published in: Radiation Oncology | Issue 1/2019

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Abstract

Background

Radiation or radiochemotherapy is a common adjuvant therapy for gastric cancer. Intensity-modulated radiation therapy (IMRT) has been demonstrated to provide better dose conformity, allowing dose escalation and/or reduction of normal tissue exposure compared with three-dimensional conformal radiation treatment (3D-CRT). However, the efficacy of IMRT and 3D-CRT in gastric cancer remains controversial. This study aimed to compare the efficacy and safety of IMRT with those of 3D-CRT in treating patients with gastric cancer through conducting a meta-analysis of 3-year survival rates [overall survival (OS) and disease-free survival (DFS)], local control rates, and toxic event rates.

Methods

Embase, PubMed, the Cochrane Library, and clinical trial databases were searched to identify the clinical trials of IMRT versus 3D-CRT for treating patients with gastric cancer. The obtained data of survival and safety were analyzed using the Stata 14.0 software.

Results

A total of 9 controlled clinical studies, including 516 patients with gastric cancer, met the inclusion criteria and were included in this meta-analysis. The results of the meta-analysis showed that the 3-year OS rate was slightly higher in the IMRT group than in the 3D-CRT group, without any statistical significance. The 3-year local control rate was significantly higher in the IMRT group than in the 3D-CRT group. No significant difference in the 3-year DFS rate was found between the IMRT and 3D-CRT groups. Grade 2–4 toxicities were similar between the IMRT and 3D-CRT groups.

Conclusion

The findings suggested that IMRT might be superior to 3D-CRT in treating patients with gastric cancer in terms of local control rates without increasing toxicity.
Appendix
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Literature
1.
Nie Y, Wu K, Yu J, Liang Q, Cai X, Shang Y, et al. A global burden of gastric cancer: the major impact of China. Expert Rev Gastroenterol Hepatol. 2017:1–11.
2.
3.
Park JY, von Karsa L, Herrero R. Prevention strategies for gastric cancer: a global perspective. Clin Endosc. 2014;47:478–89.CrossRef
4.
Kamran SC, Hong TS, Wo JY. Advances in the Management of Gastric and Gastroesophageal Cancers. Curr Oncol Rep. 2016;18:13.CrossRef
5.
Laks S, Meyers MO, Kim HJ. Surveillance for gastric cancer. Surg Clin North Am. 2017;97:317–31.CrossRef
6.
Park CH, Park JC, Chung H, Shin SK, Lee SK, Cheong JH, et al. Impact of the surveillance interval on the survival of patients who undergo curative surgery for gastric Cancer. Ann Surg Oncol. 2016;23:539–45.CrossRef
7.
Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Nakajima T, et al. Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection. Endoscopy. 2015;47:1113–8.CrossRef
8.
Lee JH, Lim JK, Kim MG, Kwon SJ. The influence of post-operative surveillance on the prognosis after curative surgery for gastric cancer. Hepatogastroenterology. 2014;61:2123–32.PubMed
9.
Colquhoun A, Arnold M, Ferlay J, Goodman KJ, Forman D, Soerjomataram I. Global patterns of cardia and non-cardia gastric cancer incidence in 2012. Gut. 2015;64:1881–8.CrossRef
10.
Dai Q, Jiang L, Lin RJ, Wei KK, Gan LL, Deng CH, et al. Adjuvant chemoradiotherapy versus chemotherapy for gastric cancer: a meta-analysis of randomized controlled trials. J Surg Oncol. 2015;111:277–84.CrossRef
11.
Oblak I, Vidmar MS, Anderluh F, Velenik V, Jeromen A. Capecitabine in postoperative radiochemotherapy for gastric adenocarcinoma. Ann Oncol. 2013;24:iv42.CrossRef
12.
Boda-Heggemann J, Hofheinz RD, Weiss C, Mennemeyer P, Mai SK, Hermes P, et al. Combined adjuvant radiochemotherapy with IMRT/XELOX improves outcome with low renal toxicity in gastric cancer. Int J Radiat Oncol Biol Phys. 2009;75:1187–95.CrossRef
13.
Isa N. Evidence based radiation oncology with existing technology. Rep Pract Oncol Radiother. 2014;19:259–66.CrossRef
14.
Valentini V, Cellini F, Minsky BD, Mattiucci GC, Balducci M, D'Agostino G, et al. Survival after radiotherapy in gastric cancer: systematic review and meta-analysis. Radiother Oncol. 2009;92:176–83.CrossRef
15.
Zhou ML, Kang M, Li GC, Guo XM, Zhang Z. Postoperative chemoradiotherapy versus chemotherapy for R0 resected gastric cancer with D2 lymph node dissection: an up-to-date meta-analysis. World J Surg Oncol. 2016;14:209.CrossRef
16.
Li LL, Xie CY, Su HF. Benefit of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis. Tumour Biol. 2014;35:4957–66.CrossRef
17.
Smalley SR, Benedetti JK, Haller DG, Hundahl SA, Estes NC, Ajani JA, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012;30:2327–33.CrossRef
18.
Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.CrossRef
19.
Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–30.CrossRef
20.
Kassam Z, Lockwood G, O'Brien C, Brierley J, Swallow C, Oza A, et al. Conformal radiotherapy in the adjuvant treatment of gastric cancer: review of 82 cases. Int J Radiat Oncol Biol Phys. 2006;65:713–9.CrossRef
21.
Hawrylewicz L, Leszczyński W, Namysł-Kaletka A, Bronclik I, Wydmański J. Protection of organs at risk during neoadjuvant chemoradiotherapy for gastric cancer based on a comparison between conformal and intensity-modulated radiation therapy. Oncol Lett. 2016;12:692–8.CrossRef
22.
Wang X, Shen Y, Zhu H, Zhao Y, Li Z, Qiu M, et al. A phase II trial of concurrent 3D-CRT/IMRT and oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX) in gastric cancer patients with R0 gastrectomy and D2 lymph node dissection. Gastric Cancer. 2016;19:245–54.CrossRef
23.
Chopra S, Agarwal A, Engineer R, Dora T, Thomas B, Sonawone S, et al. Intensity modulated radiation therapy (IMRT) is not superior to three-dimensional conformal radiation (3DCRT) for adjuvant gastric radiation: a matched pair analysis. J Cancer Res Ther. 2015;11:623–9.CrossRef
24.
Zhang T, Liang ZW, Han J, Bi JP, Yang ZY, Ma H. Double-arc volumetric modulated therapy improves dose distribution compared to static gantry IMRT and 3D conformal radiotherapy for adjuvant therapy of gastric cancer. Radiat Oncol. 2015;10:114.CrossRef
25.
Fang L. Short/mid-term efficacy and adverse reactions of three postoperative radiotherapy modalities for patients with gastric cancer. J Pract Oncol. 2015;30:367–70.
26.
Liu GF, Bair RJ, Bair E, Liauw SL, Koshy M. Clinical outcomes for gastric cancer following adjuvant chemoradiation utilizing intensity modulated versus three-dimensional conformal radiotherapy. PLoS One. 2014;9:e82642.CrossRef
27.
Ling TC, Slater JM, Nookala P, Mifflin R, Grove R, Ly AM, et al. Analysis of intensity-modulated radiation therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) for reducing perioperative cardiopulmonary complications in esophageal cancer patients. Cancers. 2014;6:2356–68.CrossRef
28.
Dhanireddy B, Mourad WF, Patel S, Concert C, Ryniak M, Shourbaji RA, et al. The impact of different radiation therapy techniques on oncologic and functional outcomes of locally advanced laryngeal cancer. Int J Radiat Oncol Biol Phys. 2014;90:S538.CrossRef
29.
Minn AY, Hsu A, La T, Kunz P, Fisher GA, Ford JM, et al. Comparison of intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy as adjuvant therapy for gastric cancer. Cancer. 2010;116:3943–52.CrossRef
30.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.CrossRef
31.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.CrossRef
32.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.CrossRef
33.
van Enst WA, Ochodo E, Scholten RJ, Hooft L, Leeflang MM. Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological study. BMC Med Res Methodol. 2014;14:70.CrossRef
34.
Boda-Heggemann J, Weiss C, Schneider V, Hofheinz RD, Haneder S, Michaely H, et al. Adjuvant IMRT/XELOX radiochemotherapy improves long-term overall- and disease-free survival in advanced gastric cancer. Strahlenther Onkol. 2013;189:417–23.CrossRef
35.
Goody RB, Mackay H, Pitcher B, Oza AM, Brlerley JD, Kim JHJ, et al. Prospective evaluation of quality of life (QOL) during a phase I/II study of adjuvant chemotherapy with image-guided high-precision radiotherapy for completely resected gastric cancer. J Clin Oncol. 2016;34.
36.
Deng QH, Li P, Yan FQ, Liu P, Lu K, Tang ZZ, et al. Comparison of desimetric parameters between IMRT and 3D-CRT for postoperative irradiation in locally advanced gastric carcinoma. Chinese J Cancer Prev Treat. 2011;18:713–5.
37.
Murthy KK, Shukeili KA, Kumar SS, Davis CA, Chandran RR, Namrata S. Evaluation of dose coverage to target volume and normal tissue sparing in the adjuvant radiotherapy of gastric cancers: 3D-CRT compared with dynamic IMRT. Biomedical Imaging Interv J. 2010;6.
38.
Ringash J, Perkins G, Brierley J, Lockwood G, Islam M, Catton P, et al. IMRT for adjuvant radiation in gastric cancer: a preferred plan? Int J Radiat Oncol Biol Phys. 2005;63:732–8.CrossRef
39.
Wei-gang HU, Zhen Z, Zhi-yong XU, Wei-lie GU, Hui-Zhong L, Shao-qin H. Comparison of dosimetry between three-dimension conformal and intensity modulated plan in postoperative radiotherapy for gastric cancer. Chinese J Radiat Oncol. 2007;16:273–6.
40.
Wieland P, Dobler B, Mai S, Hermann B, Tiefenbacher U, Steil V, et al. IMRT for postoperative treatment of gastric cancer: covering large target volumes in the upper abdomen: a comparison of a step-and-shoot and an arc therapy approach. Int J Radiat Oncol Biol Phys. 2004;59:1236–44.CrossRef
Metadata
Title
Efficacy and safety of intensity-modulated radiation therapy versus three-dimensional conformal radiation treatment for patients with gastric cancer: a systematic review and meta-analysis
Authors
Fang Ren
Shaodan Li
Yin Zhang
Zhifei Zhao
Haiming Wang
Yixin Cui
Maoyun Wang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-019-1294-0

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