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Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies: a systematic review and meta-analysis.

Yang B, Zhu L, Cheng H, Li Q, Zhang Y, Zhao Y - Radiat Oncol (2012)

Bottom Line: Reduction in irradiated small bowel was also observed for IMRT-delivered 40 Gy and 45 Gy (by 17.80% (p = 0.043) and 17.30% (p = 0.012), respectively), as compared with 3D-CRT.IMRT-treated patients did not experience more severe acute or chronic toxicities than 3D-CRT-treated patients.IMRT-delivered high radiation dose produced significantly less average percent volumes of irradiated rectum and small bowel than 3D-CRT, but did not differentially affect the average percent volumes in the bladder and bone marrow.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gynecologic Oncology, Cancer Hospital of Harbin Medical University, 150 Haping Street, Nangang District, Harbin, Heilongjiang Province, PR China.

ABSTRACT

Background: To quantitatively evaluate the safety and related-toxicities of intensity modulated radiotherapy (IMRT) dose-volume histograms (DVHs), as compared to the conventional three-dimensional conformal radiotherapy (3D-CRT), in gynecologic malignancy patients by systematic review of the related publications and meta-analysis.

Methods: Relevant articles were retrieved from the PubMed, Embase, and Cochrane Library databases up to August 2011. Two independent reviewers assessed the included studies and extracted data. Pooled average percent irradiated volumes of adjacent non-cancerous tissues were calculated and compared between IMRT and 3D-CRT for a range of common radiation doses (5-45 Gy).

Results: In total, 13 articles comprised of 222 IMRT-treated and 233 3D-CRT-treated patients were included. For rectum receiving doses ≥30 Gy, the IMRT pooled average irradiated volumes were less than those from 3D-CRT by 26.40% (30 Gy, p = 0.004), 27.00% (35 Gy, p = 0.040), 37.30% (40 Gy, p = 0.006), and 39.50% (45 Gy, p = 0.002). Reduction in irradiated small bowel was also observed for IMRT-delivered 40 Gy and 45 Gy (by 17.80% (p = 0.043) and 17.30% (p = 0.012), respectively), as compared with 3D-CRT. However, there were no significant differences in the IMRT and 3D-CRT pooled average percent volumes of irradiated small bowel or rectum from lower doses, or in the bladder or bone marrow from any of the doses. IMRT-treated patients did not experience more severe acute or chronic toxicities than 3D-CRT-treated patients.

Conclusions: IMRT-delivered high radiation dose produced significantly less average percent volumes of irradiated rectum and small bowel than 3D-CRT, but did not differentially affect the average percent volumes in the bladder and bone marrow.

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Funnel plots for pooled average percent irradiated volume.A. Small bowel at 45Gy with IMRT. B. Small bowel at 45Gy with 3D-CRT. C. Rectum at 30Gy with IMRT. D. Rectum at 30Gy with 3D-CRT.
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Figure 2: Funnel plots for pooled average percent irradiated volume.A. Small bowel at 45Gy with IMRT. B. Small bowel at 45Gy with 3D-CRT. C. Rectum at 30Gy with IMRT. D. Rectum at 30Gy with 3D-CRT.

Mentions: The graphical funnel plots of pooled average percentage volumes of small bowel irradiated at 45 Gy and rectum irradiated at 30 Gy by IMRT and 3D-CRT are shown in Figure 2. Although the dots were not entirely localized to the bottom of the inverted funnel plots, they were distributed symmetrically around the central axis. Using the Begg’s rank correlation method and Egger’s linear regression approach, we identified publication bias for the 40 Gy and 45 Gy radiation dose of the rectum with 3D-CRT and for the 10 Gy, 25 Gy, and 40 Gy radiation doses of the rectum with IMRT. Publication bias was also found in several radiation dose levels of small bowel with both IMRT and 3D-CRT, with the exceptions of 20 Gy, 30 Gy, and 35 Gy with IMRT and 5 Gy, 25 Gy, and 30 Gy with 3D-CRT. The results for the bladder and bone marrow very nearly indicated publication bias for all radiation doses, except for 25 Gy for the bladder and 15 Gy for bone marrow. The detailed results are presented in Table 2.


Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies: a systematic review and meta-analysis.

Yang B, Zhu L, Cheng H, Li Q, Zhang Y, Zhao Y - Radiat Oncol (2012)

Funnel plots for pooled average percent irradiated volume.A. Small bowel at 45Gy with IMRT. B. Small bowel at 45Gy with 3D-CRT. C. Rectum at 30Gy with IMRT. D. Rectum at 30Gy with 3D-CRT.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539899&req=5

Figure 2: Funnel plots for pooled average percent irradiated volume.A. Small bowel at 45Gy with IMRT. B. Small bowel at 45Gy with 3D-CRT. C. Rectum at 30Gy with IMRT. D. Rectum at 30Gy with 3D-CRT.
Mentions: The graphical funnel plots of pooled average percentage volumes of small bowel irradiated at 45 Gy and rectum irradiated at 30 Gy by IMRT and 3D-CRT are shown in Figure 2. Although the dots were not entirely localized to the bottom of the inverted funnel plots, they were distributed symmetrically around the central axis. Using the Begg’s rank correlation method and Egger’s linear regression approach, we identified publication bias for the 40 Gy and 45 Gy radiation dose of the rectum with 3D-CRT and for the 10 Gy, 25 Gy, and 40 Gy radiation doses of the rectum with IMRT. Publication bias was also found in several radiation dose levels of small bowel with both IMRT and 3D-CRT, with the exceptions of 20 Gy, 30 Gy, and 35 Gy with IMRT and 5 Gy, 25 Gy, and 30 Gy with 3D-CRT. The results for the bladder and bone marrow very nearly indicated publication bias for all radiation doses, except for 25 Gy for the bladder and 15 Gy for bone marrow. The detailed results are presented in Table 2.

Bottom Line: Reduction in irradiated small bowel was also observed for IMRT-delivered 40 Gy and 45 Gy (by 17.80% (p = 0.043) and 17.30% (p = 0.012), respectively), as compared with 3D-CRT.IMRT-treated patients did not experience more severe acute or chronic toxicities than 3D-CRT-treated patients.IMRT-delivered high radiation dose produced significantly less average percent volumes of irradiated rectum and small bowel than 3D-CRT, but did not differentially affect the average percent volumes in the bladder and bone marrow.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gynecologic Oncology, Cancer Hospital of Harbin Medical University, 150 Haping Street, Nangang District, Harbin, Heilongjiang Province, PR China.

ABSTRACT

Background: To quantitatively evaluate the safety and related-toxicities of intensity modulated radiotherapy (IMRT) dose-volume histograms (DVHs), as compared to the conventional three-dimensional conformal radiotherapy (3D-CRT), in gynecologic malignancy patients by systematic review of the related publications and meta-analysis.

Methods: Relevant articles were retrieved from the PubMed, Embase, and Cochrane Library databases up to August 2011. Two independent reviewers assessed the included studies and extracted data. Pooled average percent irradiated volumes of adjacent non-cancerous tissues were calculated and compared between IMRT and 3D-CRT for a range of common radiation doses (5-45 Gy).

Results: In total, 13 articles comprised of 222 IMRT-treated and 233 3D-CRT-treated patients were included. For rectum receiving doses ≥30 Gy, the IMRT pooled average irradiated volumes were less than those from 3D-CRT by 26.40% (30 Gy, p = 0.004), 27.00% (35 Gy, p = 0.040), 37.30% (40 Gy, p = 0.006), and 39.50% (45 Gy, p = 0.002). Reduction in irradiated small bowel was also observed for IMRT-delivered 40 Gy and 45 Gy (by 17.80% (p = 0.043) and 17.30% (p = 0.012), respectively), as compared with 3D-CRT. However, there were no significant differences in the IMRT and 3D-CRT pooled average percent volumes of irradiated small bowel or rectum from lower doses, or in the bladder or bone marrow from any of the doses. IMRT-treated patients did not experience more severe acute or chronic toxicities than 3D-CRT-treated patients.

Conclusions: IMRT-delivered high radiation dose produced significantly less average percent volumes of irradiated rectum and small bowel than 3D-CRT, but did not differentially affect the average percent volumes in the bladder and bone marrow.

Show MeSH
Related in: MedlinePlus