An Improved Approach to External Beam Radiation Therapy for Intra-Abdominal Cavity Lesions for Rural Cancer Centers

Radiation therapy of abdominal lesions is problematic at best. The proximity of highly critical structures, tumor locations, and necessary margins combine to make prescription dose delivery with conventional 3-dimensional (3D) conformal techniques difficult. Others have tried to overcome these hurdles with newer modalities including intra-operative radiation therapy (IORT), intensity modulated radiation therapy (IMRT), and heavy particle irradiation. These techniques have had moderate success but are not readily available and are therefore limited in application. These factors have lead to the development of a modified, noncoplanar 4-field box technique that demonstrates significant improvement in critical structure sparing, i.e., kidney(s), bowel, and liver doses reduced while simultaneously improving isodose coverage to the target.