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  • Title: Comparison of inverse-planned three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for non-small-cell lung cancer.
    Author: Christian JA, Bedford JL, Webb S, Brada M.
    Journal: Int J Radiat Oncol Biol Phys; 2007 Mar 01; 67(3):735-41. PubMed ID: 17187941.
    Abstract:
    PURPOSE: Lungs are the major dose-limiting organ during radiotherapy (RT) for non-small-cell lung cancer owing to the development of pneumonitis. This study compared intensity-modulated RT (IMRT) with three-dimensional conformal RT (3D-CRT) in reducing the dose to the lungs. METHODS: Ten patients with localized non-small-cell lung cancer underwent computed tomography (CT). The planning target volume (PTV) was defined and the organs at risk were outlined. An inverse-planning program, AutoPlan, was used to design the beam angle-optimized six-field noncoplanar 3D-CRT plans. Each 3D-CRT plan was compared with a series of five IMRT plans per patient. The IMRT plans were created using a commercial algorithm and consisted of a series of three, five, seven, and nine equidistant coplanar field arrangements and one six-field noncoplanar plan. The planning objectives were to minimize the lung dose while maintaining the dose to the PTV. The percentage of lung volume receiving >20 Gy (V20) and the percentage of the PTV covered by the 90% isodose (PTV90) were the primary endpoints. The PTV90/V20 ratio was used as the parameter accounting for both the reduction in lung volume treated and the PTV coverage. RESULTS: All IMRT plans, except for the three-field coplanar plans, improved the PTV90/V20 ratio significantly compared with the optimized 3D-CRT plan. Nine coplanar IMRT beams were significantly better than five or seven coplanar IMRT beams, with an improved PTV90/V20 ratio. CONCLUSION: The results of our study have shown that IMRT can reduce the dose to the lungs compared with 3D-CRT by improving the conformity of the plan.
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