Toxicity and dosimetric analysis of non–small cell lung cancer patients undergoing radiotherapy with 4DCT and image‐guided intensity modulated radiotherapy: a regional centre's experience. Issue 3 (15th February 2016)

• Record Type: Journal Article
• Authors: Livingston, Gareth C.; Last, Andrew J.; Shakespeare, Thomas P.; Dwyer, Patrick M.; Westhuyzen, Justin; McKay, Michael J.; Connors, Lisa; Leader, Stephanie; Greenham, Stuart
• Is Part Of: Journal of medical radiation sciences. Volume 63:Issue 3(2016:Sep.)
• Page Start: 170
• Page End: 178
• Publication Date: 2016-02-15
• Subjects: Four‐dimensional computed tomography -- image‐guided radiotherapy -- intensity modulated radiotherapy -- non–small cell lung cancer; Radiology, Medical -- Periodicals; Radiology, Medical -- Australia -- Periodicals; Radiology, Medical -- New Zealand -- Periodicals; Radiotherapy -- Periodicals; Diagnostic imaging -- Periodicals; 616
• DOI: 10.1002/jmrs.159
• Languages: English
• ISSNs: 2051-3895

Abstract

Abstract: Introduction: For patients receiving radiotherapy for locally advance non–small cell lung cancer (NSCLC), the probability of experiencing severe radiation pneumonitis (RP) appears to rise with an increase in radiation received by the lungs. Intensity modulated radiotherapy (IMRT) provides the ability to reduce planned doses to healthy organs at risk (OAR) and can potentially reduce treatment‐related side effects. This study reports toxicity outcomes and provides a dosimetric comparison with three‐dimensional conformal radiotherapy (3DCRT). Methods: Thirty curative NSCLC patients received radiotherapy using four‐dimensional computed tomography and five‐field IMRT. All were assessed for early and late toxicity using common terminology criteria for adverse events. All plans were subsequently re‐planned using 3DCRT to the same standard as the clinical plans. Dosimetric parameters for lungs, oesophagus, heart and conformity were recorded for comparison between the two techniques. Results: IMRT plans achieved improved high‐dose conformity and reduced OAR doses including lung volumes irradiated to 5–20 Gy. One case each of oesophagitis and erythema (3%) were the only Grade 3 toxicities. Rates of Grade 2 oesophagitis were 40%. No cases of Grade 3 RP were recorded and Grade 2 RP rates were as low as 3%. Conclusion: IMRT provides a dosimetric benefit when compared to 3DCRT. While the clinical benefit appears to increase with increasing target size and increasing complexity, IMRT appears preferential to 3DCRT in the treatment of NSCLC. Abstract : Intensity modulated radiotherapy (IMRT) can reduce the dose to surrounding organs and healthy tissue for non–small cell lung cancer (NCSLC) patients beyond what is achievable with conventional radiotherapy. We report favourable toxicity outcomes including zero instances of Grade 3 pneumonitis in 30 patients. Four‐dimensional computed tomography and daily soft tissue aligned IMRT is an excellent radiotherapy technique for patients with inoperable NSCLC.