Intraindividual Comparison of Conventional Three-Dimensional Radiotherapy and Intensity Modulated Radiotherapy in the Therapy of Locally Advanced Non-Small Cell Lung Cancer

Marnitz, Simone; Stuschke, Martin; Bohsung, Jörg; Moys, Anne; Reng, Ines; Würm, Reinhard; Budach, Volker

doi:10.1007/s00066-002-0939-2

Cited by 26 publications

(20 citation statements)

References 41 publications

(71 reference statements)

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“…The intensity-modulated radiotherapy offers an opportunity of dose escalation and may provide another tool for improving local control and survival [20].…”

Section: Discussionmentioning

confidence: 99%

Concurrent Radiochemotherapy with Vinorelbine plus Cisplatin or Carboplatin in Patients with Locally Advanced Non-Small-Cell Lung Cancer (NSCLC) and an Increased Risk of Treatment Complications

et al. 2003

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“…The intensity-modulated radiotherapy offers an opportunity of dose escalation and may provide another tool for improving local control and survival [20].…”

Section: Discussionmentioning

confidence: 99%

Concurrent Radiochemotherapy with Vinorelbine plus Cisplatin or Carboplatin in Patients with Locally Advanced Non-Small-Cell Lung Cancer (NSCLC) and an Increased Risk of Treatment Complications

et al. 2003

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“…The advent of 3DCRT and consequent improvements in toxicity profiles also initiated a series of phase I and II dose-escalation trials that occurred in parallel with development of IMRT. Several authors showed that with the same dose constraints, up to 35% greater RT doses could be given to the target with IMRT than 3DCRT, with the aim of improving local control (23,25,57). Armed with this favorable dosimetric data on toxicity and significant improvements already demonstrated with 3DCRT, several institutions initiated dose-escalation trials in the 1990s and 2000s.…”

Section: Impact Of Heterogeneity Correctionmentioning

confidence: 99%

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Diwanji¹,

Mohindra²,

Vyfhuis³

et al. 2017

Transl. Lung Cancer Res.

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Abstract:The 21st century has seen several paradigm shifts in the treatment of non-small cell lung cancer (NSCLC) in early-stage inoperable disease, definitive locally advanced disease, and the postoperative setting.A key driver in improvement of local disease control has been the significant evolution of radiation therapy techniques in the last three decades, allowing for delivery of definitive radiation doses while limiting exposure of normal tissues. For patients with locally-advanced NSCLC, the advent of volumetric imaging techniques has allowed a shift from 2-dimensional approaches to 3-dimensional conformal radiation therapy (3DCRT).The next generation of 3DCRT, intensity-modulated radiation therapy and volumetric-modulated arc therapy (VMAT), have enabled even more conformal radiation delivery. Clinical evidence has shown that this can improve the quality of life for patients undergoing definitive management of lung cancer. In the earlystage setting, conventional fractionation led to poor outcomes. Evaluation of altered dose fractionation with the previously noted technology advances led to advent of stereotactic body radiation therapy (SBRT). This technique has dramatically improved local control and expanded treatment options for inoperable, earlystage patients. The recent development of proton therapy has opened new avenues for improving conformity and the therapeutic ratio. Evolution of newer proton therapy techniques, such as pencil-beam scanning (PBS), could improve tolerability and possibly allow reexamination of dose escalation. These new progresses, along with significant advances in systemic therapies, have improved survival for lung cancer patients across the spectrum of non-metastatic disease. They have also brought to light new challenges and avenues for further research and improvement.

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“…A proven method for improving the conformality of a dose distribution is intensity modulated radiation therapy (IMRT). ( 1 – 4 ) Clinicians are hesitant to treat non‐small‐cell lung cancer patients with IMRT, even though clinical studies have demonstrated that an escalation in radiation dose results in significant improvement in the outcome of these patients. ( 5 , 6 ) The reluctance is due to organ motion effects, including dose blurring effect and interplay effect (7) …”

Section: Introductionmentioning

confidence: 99%

Measurement of the interplay effect in lung IMRT treatment using EDR2 films

Berbeco

Pope

Jiang

2006

J Applied Clin Med Phys

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Intrafraction organ motion during the dynamic delivery of intensity‐modulated radiation therapy (IMRT) treatment of lung tumors may cause unexpected hot/cold spots within the target volume, due to the interplay effect between tumor motion and multileaf collimator (MLC) leaf motion. In the past, this has been investigated through theoretical analysis, computer simulation, and experimental measurement using an ionization chamber dosimeter. In the work presented here, the interplay effect was studied experimentally in 2D, using Kodak EDR2 films. A five‐field lung IMRT plan was delivered to a solid water phantom with embedded film. The phantom was placed on a motor‐driven platform with a sinusoidal motion to simulate the respiration‐induced tumor motion. The delivery of each field began at one of eight equally spaced initial breathing phases. The dose distribution for each treatment fraction was estimated by combining the dose distributions for all fields with randomly sampled initial breathing phases. The dose variation caused by the interplay effect was estimated by looking at the dose values from 1000 trials of 30 fractions. It was found that, on a day‐to‐day basis, the standard deviation of the dose to a given pixel in the high‐dose region could be as high as 2% to 4% due to the motion interplay effect. After 30 fractions, the standard deviation in the dose to each pixel is reduced to 0.4% to 0.7%. However, compared to the static delivery, the dose distribution from a 30‐fraction case in the presence of motion shows some underdosing in the region of interest. We found that the maximum dose in the target remains within 1% of the maximum dose in the static case, but the minimum dose in the target is most likely to be about 6% lower than the static case. Our results indicate that there can be some underdosing of the tumor due to the interplay effect in lung IMRT delivery over the entire course of a 30‐fraction treatment.PACS number: 87.53.Mr

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Intraindividual Comparison of Conventional Three-Dimensional Radiotherapy and Intensity Modulated Radiotherapy in the Therapy of Locally Advanced Non-Small Cell Lung Cancer

Abstract: IMRT gives the possibility of further dose escalation without an increasing mean lung dose especially in patients with large tumors.

Cited by 26 publications

References 41 publications

Concurrent Radiochemotherapy with Vinorelbine plus Cisplatin or Carboplatin in Patients with Locally Advanced Non-Small-Cell Lung Cancer (NSCLC) and an Increased Risk of Treatment Complications

Concurrent Radiochemotherapy with Vinorelbine plus Cisplatin or Carboplatin in Patients with Locally Advanced Non-Small-Cell Lung Cancer (NSCLC) and an Increased Risk of Treatment Complications

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Measurement of the interplay effect in lung IMRT treatment using EDR2 films

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