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Volume 21, Number 5, 2016

Superior sulcus non-small cell lung carcinoma: A comparison of IMRT and 3D-RT dosimetry

Pierre Truntzer, Delphine Antoni, Nicola Santelmo, Catherine Schumacher, Pierre-Emmanuel Falcoz, Elisabeth Quoix, Gilbert Massard, Georges Noël

Summary:

Aim

A dosimetric study comparing intensity modulated radiotherapy (IMRT) by TomoTherapy to conformational 3D radiotherapy (3D-RT) in patients with superior sulcus non-small cell lung cancer (NSCLC).

Background

IMRT became the main technique in modern radiotherapy. However it was not currently used for lung cancers. Because of the need to increase the dose to control lung cancers but because of the critical organs surrounding the tumors, the gains obtainable with IMRT is not still demonstrated.

Material and methods

A dosimetric comparison of the planned target and organs at risk parameters between IMRT and 3D-RT in eight patients who received preoperative or curative intent irradiation.

Results

In the patients who received at least 66 Gy, the mean V95% was significantly better with IMRT than 3D-RT (p = 0.043). IMRT delivered a lower D2% compared to 3D-RT (p = 0.043). The IH was significantly better with IMRT (p = 0.043). The lung V5 Gy and V13 Gy were significantly higher in IMRT than 3D-RT (p = 0.043), while the maximal dose (Dmax) to the spinal cord was significantly lower in IMRT (p = 0.043). The brachial plexus Dmax was significantly lower in IMRT than 3D-RT (p = 0.048). For patients treated with 46 Gy, no significant differences were found.

Conclusion

Our study showed that IMRT is relevant for SS-NSCLC. In patients treated with a curative dose, it led to a reduction of the exposure of critical organs, allowing a better dose distribution in the tumor. For the patients treated with a preoperative schedule, our results provide a basis for future controlled trials to improve the histological complete response by increasing the radiation dose.

Signature: Rep Pract Oncol Radiother, 2016; 21(5) : 427-434


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Indexed in: EMBASE®, the Excerpta Medica database, the Elsevier BIOBASE (Current Awareness in Biological Sciences) and in the Index Copernicus.

http://www.sciencedirect.com/science/journal/15071367/19/2