Combining advanced radiotherapy technologies to maximize safety and tumor control probability in stage III non-small cell lung cancer

Background The goal of the current study was to investigate the tumor control probability (TCP) of advanced radiotherapy technologies for stage III non-small cell lung cancer (NSCLC) and to evaluate potential interplay effects between their applications. Materials and methods Three-dimensional confo...

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Bibliographic Details
Published in:Strahlentherapie und Onkologie 2012-10, Vol.188 (10), p.894-900
Main Authors: Guckenberger, M., Kavanagh, A., Partridge, M.
Format: Article
Language:English
Subjects:
Adult
Aged
Carcinoma, Non-Small-Cell Lung - diagnostic imaging
Carcinoma, Non-Small-Cell Lung - pathology
Carcinoma, Non-Small-Cell Lung - radiotherapy
Combined Modality Therapy - methods
Computer Simulation
Dose-Response Relationship, Radiation
Humans
Lung Neoplasms - diagnostic imaging
Lung Neoplasms - pathology
Lung Neoplasms - radiotherapy
Male
Medicine
Medicine & Public Health
Middle Aged
Models, Biological
Neoplasm Staging
Oncology
Original Article
Radiography
Radiotherapy
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted - methods
Risk Assessment
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Summary:Background The goal of the current study was to investigate the tumor control probability (TCP) of advanced radiotherapy technologies for stage III non-small cell lung cancer (NSCLC) and to evaluate potential interplay effects between their applications. Materials and methods Three-dimensional conformal radiotherapy (3D-CRT) with conventionally fractionated doses of 66 Gy served as reference for 13 patients with stage III NSCLC. Isotoxic dose escalation relative to the corresponding 3D-CRT plans was performed for three technologies and their combinations: intensity-modulated radiotherapy (IMRT), IMRT with a simultaneous integrated boost (IMRT-SIB) of 10% to the gross tumor volume (GTV), and adaptive re-planning twice during the treatment course (ART). All analyses were based on accumulated dose distributions using deformable image registration of CT images, which were acquired weekly during the treatment course. Results IMRT reduced the mean lung dose (MLD) by 5.6% ± 3.8% compared to 3D-CRT. ART resulted in lung sparing of 7.9% ± 4.8% and 9.2% ± 3.9% in 3D-CRT and IMRT planning, respectively. IMRT and ART escalated the irradiation dose by 6.6% ± 3.2% and 8.8% ± 6.3%, respectively, which was not statistically different. For the 7 patients with the largest GTVs, IMRT-SIB was superior to IMRT and ART with dose escalation of 11.9% ± 3.7%. The combination of ART, IMRT, and SIB achieved maximum dose escalation in all 13 patients by 17.1% ± 5.4% on average, which increased TCP from 19.9% ± 7.0 to 37.1% ± 10.1%. Adaptive re-planning was required to continuously conform the escalated and hypofractionated SIB doses to the shrinking tumor. Conclusion Combining advanced radiotherapy technologies is considered as a safe and effective strategy to maximize local tumor control probability in stage III NSCLC.
ISSN:0179-7158
1439-099X
DOI:10.1007/s00066-012-0161-9