Figure 1

VMAT treatment plans for gastric and GEJ carcinomas. (a-c): Volumetric intensity-modulated arc therapy (VMAT) plan (Monaco®, Elekta, Crawley, UK) of a patient with a junctional carcinoma in the adjuvant situation. Transversal (a), coronal (b), and sagittal (c) dose distributions. Color wash and isodose lines are indexed in the insert. A total dose of 45Gy was applied. Note the expansion of the planning target volume (PTV) to the distal esophagus and sparing of the posterior wall of the heart, both lungs, and the dorsolateral renal cortex in the left kidney. (d): Cone beam computed tomography (CBCT) based position correction directly before the first therapy fraction after positioning based on skin marks. Magenta: planning computed tomography (PCT); green: CBCT; both PCT and CBCT in mid-ventilation position. Manual position correction was based on internal surrogate structures such as calcifications in the aorta. (e-g): VMAT plan of a patient with stomach (corpus) carcinoma in the adjuvant situation. Transversal (e), coronal (f) and sagittal (g) dose distributions. Color wash and isodose lines are indexed in the insert. A total dose of 45Gy was applied. Note the sparing of the dorsolateral renal cortex in the left kidney and the complete right kidney. (h): CBCT based position correction directly before the first therapy fraction. Magenta: PCT; green: CBCT.