Reduced acute and late toxicities with intensity-modulated radiation therapy compared to three-dimensional conformal radiation therapy in post-operative gastric cancer

  • Ashwin Shinde
  • Wei-Hsien Hou
  • Chunhui Han
  • Scott Glaser
  • Joseph Chao
  • Yanghee Woo
  • Jeffrey Wong
  • Yi-Jen ChenEmail author
Original Research



The role of intensity-modulated radiation therapy (IMRT) in post-operative gastric cancer is unknown. We evaluated the toxicity profiles of post-operative gastric cancer patients treated with IMRT or three-dimensional conformal radiation therapy (3D-CRT).


We identified patients with gastric cancer treated with post-operative radiation at our institution between 2002 and 2016. Acute and late toxicities were evaluated per RTOG/EORTC Radiation Toxicity Grading Scale. Statistical analysis was performed using Chi-square tests, t tests, log-rank, and logistic regression.


We identified 66 patients who underwent surgical resection as part of planned definitive treatment. Eighty percent of patients had T3 or higher disease, while 67% had N2+ disease.

Thirty patients received 3D-CRT, while 36 received IMRT. Patients receiving 3D-CRT were younger in age than IMRT, treated longer ago, and did not receive neoadjuvant chemotherapy.

Acute grade 2 lower GI toxicity was higher with 3D-CRT (40% vs 17%, p = 0.04). 3D-CRT had higher rates of late lung toxicity of any grade (23% vs 3%, p = 0.02), grade 3+ late esophageal toxicity (23% vs 3%, p = 0.02), and grade 2+ late intestinal toxicity (19% vs 0% p = 0.01).

Dosimetric analysis showed that keeping Bowel V5 ≤ 93% protected against development of acute lower GI toxicity of any grade, with V5 ≤ 93% resulting in 10.5% incidence, and V5 > 93% resulting in 52% incidence (p = 0.004).


Use of IMRT in post-operative gastric cancer is associated with reduced acute and late toxicities. Consideration should be given for prospective evaluation in the future.


Gastric cancer Post-operative radiation Intensity modulated Conformal Toxicities 


Compliance with ethical standards


This study received no funding.

Conflicts of interest

All authors declare that they have no conflicts of interest. Ashwin Shinde declares that he has no conflicts of interest. Wei-Hsien Hou declares that he has no conflicts of interest. Chunhui Han declares that he has no conflicts of interest. Scott Glaser declares that he has no conflicts of interest. Yanghee Woo declares that she has no conflicts of interest. Joseph Chao declares that he has no conflicts of interest. Jeffrey Wong declares that he has no conflicts of interest. Yi-Jen Chen declares that he has no conflicts of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed were in accordance with ethical standards of the institutional review board and consistent with the 1964 Helsinki declaration and its later amendments.

Informed consent

Individualized patient consent for this retrospective review was waived by the institutional review board due to the difficulty with reaching this patient population, as most had either passed away or were lost to follow-up.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyCity of Hope National Medical CenterDuarteUSA
  2. 2.Department of Medical OncologyCity of Hope National Medical CenterDuarteUSA
  3. 3.Department of SurgeryCity of Hope National Medical CenterDuarteUSA

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