Adaptive radiotherapy for locally advanced non-small cell lung cancer, can we predict when and for whom?
| Autor: | Veerle Surmont, Cristina Derie, Patrick Berkovic, Wilfried J. De Neve, Leen Paelinck, Akos Gulyban, Katrien Vandecasteele, Yolande Lievens, B. Goddeeris |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Cone beam computed tomography Lung Neoplasms medicine.medical_treatment Locally advanced Carcinoma Non-Small-Cell Lung Carcinoma Humans Medicine Radiology Nuclear Medicine and imaging Adaptive radiotherapy Lung cancer Aged Aged 80 and over business.industry Dose fractionation Chemoradiotherapy Hematology General Medicine Cone-Beam Computed Tomography Middle Aged medicine.disease Radiation therapy Oncology Female Dose Fractionation Radiation Radiotherapy Intensity-Modulated business Nuclear medicine Radiotherapy Image-Guided |
| Zdroj: | Acta Oncologica. 54:1438-1444 |
| ISSN: | 1651-226X 0284-186X |
| DOI: | 10.3109/0284186x.2015.1061209 |
| Popis: | Adaptive radiotherapy (ART) could be a tool to reduce toxicity and to facilitate dose escalation in stage III NSCLC. Our aim was to identify the most appropriate time and potential benefit of ART.We analyzed volume reduction and dosimetric consequences of 41 patients who were treated with concurrent (cCRT) (n = 21) or sequential (sCRT) chemoradiotherapy to a median dose of 70 Gy, 2 Gy/F. At every treatment fraction a cone-beam CT (CBCT) was performed. The gross tumor volume (GTV-T) was adapted (exclusion of lymph nodes) to create the GTV-T-F1. Every fifth fraction (F5-F30), the GTV-T-F1 was adapted on the CBCT to create a GTV-T-Fx. Dose volume histograms were recalculated for every GTV-T-Fx, enabling to create lookup tables to predict the theoretical dosimetric advantage on common lung dose constraints.The average GTV reduction was 42.1% (range 4.0-69.3%); 50.1% and 33.7% for the cCRT and sCRT patients, respectively. A linear relationship between GTV-T-F1 volume and absolute volume decrease was found for both groups. The mean V5, V20, V30 and mean lung dose increased by 0.8, 3.1, 5.2 and 3.4%, respectively. A larger increase (p0.05) was observed for peripheral tumors and cCRT. Lookup tables were generated.ART offers the most beneficial dosimetric effects when performed around fraction 15, especially for patients with a large initial GTV-T treated by cCRT. |
| Databáze: | OpenAIRE |
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