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Four-dimensional computed tomography-based respiratory-gated whole-abdominal intensity-modulated radiation therapy for ovarian cancer: a feasibility study
  1. A. A. Garsa*,
  2. R. S. Andrade,
  3. D. E. Heron*,,
  4. S. Beriwal,
  5. H. Kim,
  6. E. Brandner,
  7. G. Kuo,
  8. H. Chen,
  9. K. Gerszten,
  10. J. N. Yue,
  11. M. S. Huq,
  12. J. Lee§,
  13. R. Lalonde§ and
  14. A. Wu
  1. * University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
  2. Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania;
  3. Department of Radiation Oncology, The National Cheng-kung University Hospital, Tainan, Taiwan;
  4. § D3 Advanced Radiation Planning, Pittsburgh, Pennsylvania
  5. Department of Radiologic Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
  1. Address correspondence and reprint requests to: Dwight E. Heron, MD, Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5150 Center Avenue, #545, Pittsburgh, PA 15232, USA. Email: HeronD2{at}


This study assesses the feasibility and implementation of respiratory-gated whole-abdominal intensity-modulated radiation therapy (RG-WAIMRT). Three patients were treated with RG-WAIMRT. The planning target volume (PTV1) included the entire peritoneal cavity and a pelvic boost field was created (PTV2). The dose prescribed was 30 Gy to PTV1 and 14.4 Gy to PTV2. For comparison, a conventional three-dimensional (3D) plan was generated for each patient. In the WAIMRT plan, an average of 90% of PTV1 received 30 Gy compared to 70% for the conventional 3D plan. The percent volume receiving 30 Gy (V30) for liver averaged 54% (WAIMRT) vs 43% (3D). The percent volume receiving 20 Gy (V20) for kidneys averaged 19% vs 0%, and the mean V20 for bone marrow was 74% vs 83%, respectively. Major acute toxicities were anemia (grade 2: 1/3), leukopenia (grade 3: 2/3 patients), and thrombocytopenia (grade 2: 1/3 patients, grade 3: 1/3 patients). One patient could not complete the whole-abdomen field after 19.5 Gy because of persistent nausea. No major subacute toxicity has been reported. WAIMRT demonstrated superior target coverage and reduced dose to bone marrow, with a slightly increased dose to liver and kidneys. WAIMRT is a novel and feasible technique for ovarian cancer treatment.

  • ovarian cancer
  • toxicity
  • whole-abdominal radiotherapy
  • 4D CT

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