Potential benefits of using non coplanar field and intensity modulated radiation therapy to preserve the heart in irradiation of lung tumors in the middle and lower lobes

Chapet, O.; Khodri, M.; Jalade, P.; Nguyen, D.; Flandin, I.; d’Hombres, A.; Romestaing, P.; Mornex, F.

doi:10.1016/j.radonc.2006.07.009

Cited by 41 publications

(24 citation statements)

References 30 publications

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“…The use of IMRT has been evaluated in the treatment of lung cancer and has been shown to improve dose conformity and OAR sparing [109,110]. The impact of intrafraction motion in these cases can be significant and can potentially reduce target volume coverage or cause a geographical miss and increase doses to OARs.…”

Section: Thoracic Tumoursmentioning

confidence: 99%

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Teoh

Clark²,

Wood³

et al. 2011

BJR

565

440

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ABSTRACT. Volumetric modulated arc therapy (VMAT) is a novel radiation technique, which can achieve highly conformal dose distributions with improved target volume coverage and sparing of normal tissues compared with conventional radiotherapy techniques. VMAT also has the potential to offer additional advantages, such as reduced treatment delivery time compared with conventional static field intensity modulated radiotherapy (IMRT). The clinical worldwide use of VMAT is increasing significantly. Currently the majority of published data on VMAT are limited to planning and feasibility studies, although there is emerging clinical outcome data in several tumour sites. This article aims to discuss the current use of VMAT techniques in practice and review the available data from planning and clinical outcome studies in various tumour sites including prostate, pelvis (lower gastrointestinal, gynaecological), head and neck, thoracic, central nervous system, breast and other tumour sites.

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Section: Thoracic Tumoursmentioning

confidence: 99%

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Teoh

Clark²,

Wood³

et al. 2011

BJR

565

440

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“…They saw an average dose increase as high as 35% with an evident benefit for large and concave tumors (37). Chapet et al (38) in Lyon documented significant heart sparing with IMRT. Christian et al (39) at the Institute of Royal Marsden reported that IMRT reduced the dose to the lungs and improve the conformity of the plan in dosimetric comparison to 3DCRT.…”

Section: Evolution In Imrtmentioning

confidence: 96%

“…As an advancement over 2DRT, 3D-CRT has been reported to decrease toxicity in addition to allowing a dose escalation from 60 Gy to 74 Gy in concurrent chemoradiotherapy (24)(25)(26). IMRT is considered an innovation that can successfully reduce normal tissue toxicity in locally advanced NSCLC patients (32)(33)(34)(35)(36)(37)(38)(39)(40).…”

Section: Evolution In Imrtmentioning

confidence: 99%

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

Selek¹,

Bölükbaşı²,

Welsh³

et al. 2015

Balkan Med J

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In the evolution of radiation oncology technology, improved planning and treatment delivery advanced from two-dimensional radiotherapy (2DRT) to three-dimensional conformal radiotherapy (3DCRT) two decades ago. In the last decade, intensity-modulated radiation therapy (IMRT) emerged in addition to daily image guidance and fourdimensional (4D) image-based motion management (1). Chemoradiotherapy, which was actually established mainly with a 2DRT trial-RTOG 9410, is the current standard of care in patients with inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC) when compared to sequential protocols (2-7). Currently, aggressive chemoradiotherapy is the standard, and is well accepted in highly selected septuagenarians with inoperable stage IIIB NSCLC (8). Conventional doses (60-63 Gy) of 3DCRT were well-thought-out not enough to succeed for desired local control to avoid dismal survival. There has been a significant challenge in safely escalating the radiation dose over 60 Gy, while preserving the critical organ at risk (OAR) structures (9-12). In the last decade, IMRT has been the leading improvement, and has been considered as the key solution for safe dose escalation and delivery. Other accompanying challenges are the fight with unpredictable movement of the tumor during the respiratory phases, the need to increase the accuracy of treatment delivery during each fraction, and the necessity to clarify the heterogeneity correction in treatment planning systems. The newest technology has been improved upon in recent years by 4D image-based motion capturing and the management of treatment planning, the evolution of calculation algorithms in treatment planning systems that are capable of better estimating the dose delivery to tumors and normal structures, and image-guided radiotherapy. All of these improvements increased the daily setup accuracy. There is a requirement for radiotherapy is evident in NSCLC, with than 60% of these patients requiring radiotherapy during treatment, and more than 40% of patients who receive radiotherapy receive it during the initial treatment (13,14). Therefore, due to the growing struggle with lung cancer, the current debate, based on inclusion of all modern technology, is whether IMRT has an advantage over 3DCRT in the outcomes of local control, surChemoradiotherapy is the current standard of care in patients with advanced inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC). Three-dimensional radiotherapy (3DCRT) has been a trusted method for a long time and has well-known drawbacks, most of which could be improved by Intensity Modulated Radiotherapy (IMRT). IMRT is not currently the standard treatment of locally advanced NSCLC, but almost all patients could benefit to a degree in organ at risk sparing, dose coverage conformality, or dose escalation. The most critical step for a radiation oncology department is to strictly evaluate its own technical and physical capabilities to determine the ability of IMRT to deliver an optimal treatment plan.This includes calc...

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“…In general, setup in the head-tilted position without a mouthpiece allowed for greater patient movement during treatment, while use of a mouthpiece with the head-tilted reduced movement to a level that irradiated doses to OARs when treating intracranial tumors. Unlike HT, some IMRT studies have shown that non-coplanar IMRT techniques reduce the radiation dose received by OARs adjacent to tumors in certain malignancy types (10,11). A recent study also reported that non-coplanar IMRT and volumetric-modulated arc therapy (VMAT) techniques spared the contralateral optic structures significantly better than coplanar IMRT and VMAT for treating frontotemporal high-grade glioma (12).…”

Section: Intrafractional Movementmentioning

confidence: 99%

A Feasibility Study of a Tilted Head Position in Helical Tomotherapy for Fractionated Stereotactic Radiotherapy of Intracranial Malignancies

Chung

Yoon

et al. 2015

Technol Cancer Res Treat

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Herein, we evaluated the feasibility of placing patients in a tilted head position as part of routine clinical practice for fractionated stereotactic radiotherapy (FSRT) of intracranial tumors using helical tomotherapy (HT), by assessing its dosimetric benefit and setup accuracy. We reviewed treatment plans of four cases that were to receive FSRT for brain lesions in normal and head-tilted positions. These patients underwent two computed tomography (CT) scans: first in the normal supine position and then in the supine position with the head tilted at a 458 angle. Two separate HT plans for each position were generated in these four patients, using the same planning parameters. Plans were compared for target conformity and dose homogeneity. Maximum and average doses to critical organs, including normal brain, brain stem, optic chiasm, optic nerves, and the eyes, were considered. To evaluate setup accuracy, patient movement during treatment was assessed by post-treatment megavoltage CT scans. Both HT plans achieved similar conformal and homogeneous dose coverage to the target. Head-tilted HT delivered lower average and maximum doses to critical organs in the cases where the tumor was located on the same plane with critical organs, particularly when they were not directly attached. Placement in the head-tilted position without a mouthpiece allowed for increased patient movement during treatment, while use of a mouthpiece reduced patient movement to even less than that observed for normal setup in the supine position. This pilot study showed that placement in a tilted head position for FSRT of intracranial tumors using HT may be of clinical use, but depends on the tumor location.

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Potential benefits of using non coplanar field and intensity modulated radiation therapy to preserve the heart in irradiation of lung tumors in the middle and lower lobes

Cited by 41 publications

References 30 publications

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

A Feasibility Study of a Tilted Head Position in Helical Tomotherapy for Fractionated Stereotactic Radiotherapy of Intracranial Malignancies

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