Is IMRT Superior or Inferior to 3DCRT in Radiotherapy for NSCLC? A Meta-Analysis

Hu, Xingsheng; He, Wenwu; Wen, Shimin; Feng, Xiaojuan; Fu, Xi; Liu, Yusong; Pu, Ke

doi:10.1371/journal.pone.0151988

Cited by 36 publications

(34 citation statements)

References 35 publications

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“…A recently reported meta-analysis of retrospective data assessed the impact of IMRT compared with 3D-CRT on endpoints including overall survival, radiation pneumonitis, and radiation esophagitis 27 . Although IMRT reduced the risk of radiation pneumonitis with a hazard ratio of 0.74 (0.59-0.93), there was an increased risk of radiation esophagitis with a hazard ratio of 2.47 (1.95-3.14).…”

Section: Discussionmentioning

confidence: 99%

Dosimetric advantages of intensity modulated radiation therapy in locally advanced lung cancer

Boyle

Ackerson

et al. 2017

Advances in Radiation Oncology

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PurposeRadiation therapy plays an essential role in the treatment of locally advanced lung cancer, but it inevitably leads to incidental and unnecessary dose to critical organs, including the lung, heart, and esophagus. Numerous radiation dose-volumetric parameters have been associated with increased risk of morbidity and mortality. The purpose of the present study is to quantify differences in normal tissue radiation exposure with intensity modulated radiation therapy (IMRT) compared with 3-dimensional conformal radiation therapy (3D-CRT).Methods and materialsTwenty-four consecutive patients with locally advanced lung cancer undergoing definitive IMRT were enrolled on a phase 1 protocol. For each patient, an optimized 3D-CRT plan was also designed. Plans were normalized in terms of planning target coverage with a standard dose of 60 Gy in 2-Gy fractions with a subset of patients also receiving elective nodal irradiation to a dose of 44 Gy in 2-Gy fractions. Normal tissue dosimetric comparisons were made for the lung, heart, and esophagus.ResultsIMRT decreased incidental dose to the lungs, heart, and esophagus. For lung, both V20 Gy (21.5% vs 26.5%, P < .01) and mean lung dose (11.9 Gy vs 14.9 Gy, P < .01) were improved with IMRT without a corresponding increase in V5 Gy (P = .76). For heart, there was improvement in V5 (28.9% vs 33.7%, P < .01) but no difference in V30 Gy (9.8% vs 15.9%. P = .10). For esophagus, all dosimetric endpoints were improved (V20 Gy, V45 Gy, V60 Gy, mean dose). For example, V60 was 6.5% with IMRT compared with 21% with 3D-CRT (P < .01).ConclusionsIMRT significantly decreased unnecessary dose to critical organs with equivalent coverage of planning target volumes. IMRT may therefore improve the tolerability of therapy.

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Section: Discussionmentioning

confidence: 99%

Dosimetric advantages of intensity modulated radiation therapy in locally advanced lung cancer

Boyle

Ackerson

et al. 2017

Advances in Radiation Oncology

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“…Previous studies using the US SEER-Medicare data did not find significant differences in survival outcomes between IMRT and 3D-CRT 12,13. A meta-analysis study also reported no significant survival differences 14. However, several single institution studies have reported that IMRT significantly improved the overall survival compared with 3D-CRT in the treatment of non-small cell lung cancer.…”

Section: Discussionmentioning

confidence: 94%

Comparison of survival rates between 3D conformal radiotherapy and intensity-modulated radiotherapy in patients with stage Ⅲ non–small cell lung cancer

Kong

Hong

2016

OTT

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PurposeRandomized trials showing a clear survival benefit of intensity-modulated radiotherapy (IMRT) over 3-dimensional conformal radiotherapy (3D-CRT) in the treatment of lung cancer are lacking. This study compared the survival rates of patients with stage III non-small cell lung cancer who were treated with either 3D-CRT or IMRT and analyzed the prognostic factors for survival.MethodsFrom January 2008 to July 2015, 19 patients were treated with IMRT and 30 were treated with 3D-CRT in our institution. The choice between 3D-CRT and IMRT was determined by the physician based on tumor extent and general condition of the patients. The primary endpoint of this study was overall survival. The secondary endpoints were loco-regional recurrence-free survival, distant metastasis-free survival, and the incidence of radiation-induced lung and esophageal toxicities.ResultsThe 1- and 2-year overall survival rates were 94.7% and 77.1% in the IMRT group and 76.7% and 52.5% in the 3D-CRT group, respectively. The overall survival rates of the IMRT group were higher than those of the 3D-CRT group; however, these differences were not statistically significant (P=0.072). Gross tumor volume was significantly associated with the overall survival rate. The 1- and 2-year loco-regional recurrence-free survival rates were 63.2% and 51% in the IMRT group and 67.5% and 48.1% in the 3D-CRT group (P=0.897), respectively. The 1- and 2-year distant metastasis-free survival rates were 78.9% and 68.4% in the IMRT group and 62.6% and 40.9% in the 3D-CRT group (P=0.120), respectively. Chemotherapy and treatment interruption were significantly associated with distant metastasis-free survival.ConclusionIMRT showed comparable or better overall survival compared with 3D-CRT in patients with stage III non-small cell lung cancer. To confirm the results of this study, further randomized prospective trials comparing IMRT with 3D-CRT are warranted.

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“…This work was focused on CRT which has been reported to be used 2.3 times more frequently than IMRT in NSCLC radiation therapy [25]. Prior to our optimization, beam intensities and aperture shapes were calculated in Eclipse treatment planning system for each respiratory phase, creating deliverable plans.…”

Section: Discussionmentioning

confidence: 99%

Inversed-Planned Respiratory Phase Gating in Lung Conformal Radiation Therapy

Modiri

Sabouri

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Background and Purpose Respiratory gating is a frequently-used clinical motion-management strategy in lung radiotherapy. In conventional gating, the beam is turned on during a pre-determined window; typically, around end-exhalation (EE). In this work, we postulate that the optimal gating window for each beam will be dependent on a variety of patient-specific factors, such as tumor size and location, and the extent of relative tumor and organ motion. Material and Methods In order to create optimal gating treatment plans, we started from an optimized clinical plan, created a plan per respiratory phase using the same beam arrangements, and used an inverse planning optimization approach to determine the optimal gating window for each beam and optimal beam weights, i.e., monitor units (MUs). Two pieces of information were used for optimization: (i) the state of the anatomy at each phase, extracted from 4D CT scans, and (ii) the time spent in each state, estimated from a 2-minute monitoring of the patient’s breathing motion. We retrospectively studied 15 lung cancer patients clinically treated by hypofractionated conformal radiation therapy, where 45 – 60 Gy was administered over 3 – 15 fractions using 7 – 13 beams. Mean gross tumor volume and respiratory-induced tumor motion was 82.5 cc and 1.0 cm, respectively. Results Although patients spent most of their respiratory cycle in EE, our optimal gating plans used EE for only 34% of the beams. Using optimal gating, maximum and mean doses to esophagus, heart and spinal cord were reduced by an average of 15 – 26% and the beam-on times were reduced by an average of 23% compared to equivalent single-phase EE gated plans (p < 0.034, paired, two – tailed T – test). Conclusions We introduce a personalized respiratory-gating technique where inverse planning optimization is used to determine patient- and beam-specific gating phases towards enhancing dosimetric quality of radiotherapy treatment plans.

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Is IMRT Superior or Inferior to 3DCRT in Radiotherapy for NSCLC? A Meta-Analysis

Cited by 36 publications

References 35 publications

Dosimetric advantages of intensity modulated radiation therapy in locally advanced lung cancer

Dosimetric advantages of intensity modulated radiation therapy in locally advanced lung cancer

Comparison of survival rates between 3D conformal radiotherapy and intensity-modulated radiotherapy in patients with stage Ⅲ non–small cell lung cancer

Inversed-Planned Respiratory Phase Gating in Lung Conformal Radiation Therapy

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Is IMRT Superior or Inferior to 3DCRT in Radiotherapy for NSCLC? A Meta-Analysis

Cited by 36 publications

References 35 publications

Dosimetric advantages of intensity modulated radiation therapy in locally advanced lung cancer

Dosimetric advantages of intensity modulated radiation therapy in locally advanced lung cancer

Comparison of survival rates between 3D conformal radiotherapy and intensity-modulated radiotherapy in patients with stage Ⅲ non&ndash;small cell lung cancer

Inversed-Planned Respiratory Phase Gating in Lung Conformal Radiation Therapy

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Comparison of survival rates between 3D conformal radiotherapy and intensity-modulated radiotherapy in patients with stage Ⅲ non–small cell lung cancer