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Connolly Hospital Dublin
St. Luke’s Radiation Oncology Network Dublin (5)
Author
McGibney, Carol
(3)
Armstrong, John, G
(1)
Thirion, Pierre
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BACKGROUND AND PURPOSE: Appropriate planning target volume (PTV) definition is critical for local disease eradication in the treatment of non-small cell lung cancer (NSCLC). When margins are added to the gross tumour volume (GTV) in the standard way, the PTV formed may be too large to facilitate dose escalation due to normal tissue tolerance. To increase the feasibility of dose escalation with 3-dimensional conformal radiotherapy (3DCRT), this study examines an alternative method for the formation of the PTV in NSCLC. This strategy is based on the reduced probability of tumour cells from the GTV outwards and on the associated lower dose requirements to eradicate such subclinical disease. MATERIALS AND METHODS: 3DCRT plans were generated from the CT scans of 15 patients with NSCLC (stages Ib to IIIb). Each PTV was formed by adding a margin for geometric uncertainties directly onto the GTV. The success of this approach is dependent on the volume immediately outside this smaller PTV, the Rind volume, receiving 50 Gy, the minimum dose requirement that is considered sufficient for eradication of the reduced tumour cell density in this volume. While optimizing the treatment plans for each PTV to 70 Gy, the dose distribution in the Rind volume, and the factors affecting it, were assessed. RESULTS: One hundred percent of each PTV received a minimum of 95 of the prescribed dose. The percentage of the Rind volume receiving 50 Gy or more (V50) had a median value of 94. The minimum dose in this volume, however, ranged from 5.6 to 32.1 Gy. The V50 was highest for apical tumours (96.1) and lowest for peripheral tumours (86) and correlated positively with the size of the PTV (Kendall's rank correlation (Kt)= 0.3, P=0.05) and the number of beams used (Kt= 0.3, P=0.03) but not with the conformity index. The average volume outside the Rind which still received (1)
PURPOSE: Non-small cell lung cancer (NSCLC) patients with locally advanced unresectable disease have a grim prognosis. Radiotherapeutic strategies are necessary to improve the permanent eradication of thoracic disease. The poor results achieved with conventional external beam radiation therapy reflect in part, the inadequacy of such therapy in achieving its primary objective of achieving local control. The impact of three-dimensional conformal radiation therapy (3-DCRT) on local disease eradication and its potential role in improving survival is assessed. DESIGN: This review addresses aspects of the software and hardware technology of 3-DCRT, the clinical and technical aspects of target volume definition, the use of 3-DCRT to predict radiation pneumonitis, strategies for dose escalation in NSCLC, and analyses the clinical results to date. RESULTS: Initially investigators compared the best treatment techniques devised with conventional planning techniques to those devised with 3-DCRT (1)
PURPOSE: To evaluate, preclinically, the potential for dose escalation of continuous, hyperfractionated, accelerated radiation therapy (CHART) for non small-cell lung cancer (NSCLC), we examined the strategy of omission of elective nodal irradiation with and without the application of three-dimensional conformal radiation technology (3DCRT). METHODS AND MATERIALS: 2D, conventional therapy plans were designed according to the specifications of CHART for 18 patients with NSCLC (Stages Ib, IIb, IIIa, and IIIb). Further plans were generated with the omission of elective nodal irradiation (ENI) from the treatment portals (2D minus ENI plans [2D-ENI plans]). Both sets were inserted in the patient's planning computed tomographies (CTs). These reconstructed plans were then compared to alternative, three-dimensional treatment plans which had been generated de novo, with the omission of ENI: 3D minus elective nodal irradiation (3D-ENI plans). Dose delivery to the planning target volumes (PTVs) and to the organs at risk were compared between the 3 sets of corresponding plans. The potential for dose escalation of each patient's 2D-ENI and 3D-ENI plan beyond 54 Gy, standard to CHART, was also determined. RESULTS: PTV coverage was suboptimal in the 2D CHART and the 2D-ENI plans. Only in the 3D-ENI plans did 100 of the PTV get (1)
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1)
Dose escalation of chart in non-small cell lung cancer: is three-dimensional conformal radiation therapy really necessary?
Author
McGibney, Carol
Publisher
Staff Publications- McClean, Brendan
Pub. Date
1999
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2)
Impact of intravenous contrast on target definition in radiotherapy of non small cell lung cancer
Author
McGibney, Carol
Publisher
Staff Publications- McClean, Brendan
Pub. Date
2001
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3)
Analysis of dose distribution in the �Rind� � a volume outside the PTV � in 3-dimensional conformal radiation therapy of non-small cell lung cancer
Author
McGibney, Carol
Publisher
Staff Publications- McClean, Brendan
Pub. Date
2003
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4)
The impact of three-dimensional radiation on the treatment of non-small cell lung cancer
Author
Armstrong, John, G
Pub. Date
2000
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5)
Use of 3-dimensional conformal radiation therapy (3DCRT) for radiobiologically escalated dose for non-small-cell lung cancer (NSCLC)
Author
Thirion, Pierre
Publisher
Staff Publications
Pub. Date
2001
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