Gut Liver.  2016 Mar;10(2):303-309. 10.5009/gnl15186.

A Comparison of Gastrointestinal Toxicities between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Pancreatic Cancer

  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 2Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
  • 3Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
  • 4Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.


Concurrent chemoradiotherapy (CCRT) is considered the treatment option for locally advanced pancreatic cancer, but accompanying gastrointestinal toxicities are the most common complication. With the introduction of three-dimensional conformal radiotherapy (3-D CRT) and intensity-modulated radiotherapy (IMRT), CCRT-related adverse events are expected to diminish. Here, we evaluated the benefits of radiation modalities by comparing gastrointestinal toxicities between 3-D CRT and IMRT.
Patients who received CCRT between July 2010 and June 2012 in Severance Hospital, Yonsei University College of Medicine, were enrolled prospectively. The patients underwent upper endoscopy before and 1 month after CCRT.
A total of 84 patients were enrolled during the study period. The radiotherapy modalities delivered included 3D-CRT (n=40) and IMRT (n=44). The median follow-up period from the start of CCRT was 10.6 months (range, 3.8 to 29.9 months). The symptoms of dyspepsia, nausea/vomiting, and diarrhea did not differ between the groups. Upper endoscopy revealed significantly more gastroduodenal ulcers in the 3-D CRT group (p=0.003). The modality of radiotherapy (3D-CRT; odds ratio [OR], 11.67; p=0.011) and tumor location (body of pancreas; OR, 11.06; p=0.009) were risk factors for gastrointestinal toxicities.
IMRT is associated with significantly fewer gastroduodenal injuries among patients treated with CCRT for pancreatic cancer.


Gastrointestinal toxicities; Chemoradiotherapy; Pancreatic neoplasms; Endoscopy; Radiotherapy; intensity-modulated
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