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01-02-2016 | Original Article

IMRT and 3D conformal radiotherapy with or without elective nodal irradiation in locally advanced NSCLC

A direct comparison of PET-based treatment planning

Authors: Dr. med. Jochen Fleckenstein, MD, Katharina Kremp, MD, Stephanie Kremp, MSc, Jan Palm, MD, Christian Rübe, MD, PhD

Published in: Strahlentherapie und Onkologie | Issue 2/2016

Abstract

Aim

The potential of intensity-modulated radiation therapy (IMRT) as opposed to three-dimensional conformal radiotherapy (3D-CRT) is analyzed for two different concepts of fluorodeoxyglucose positron emission tomography (FDG PET)-based target volume delineation in locally advanced non-small cell lung cancer (LA-NSCLC): involved-field radiotherapy (IF-RT) vs. elective nodal irradiation (ENI).

Methods

Treatment planning was performed for 41 patients with LA-NSCLC, using four different planning approaches (3D-CRT-IF, 3D-CRT-ENI, IMRT-IF, IMRT-ENI). ENI included a boost irradiation after 50 Gy. For each plan, maximum dose escalation was calculated based on prespecified normal tissue constraints. The maximum prescription dose (PD), tumor control probability (TCP), conformal indices (CI), and normal tissue complication probabilities (NTCP) were analyzed.

Results

IMRT resulted in statistically significant higher prescription doses for both target volume concepts as compared with 3D-CRT (ENI: 68.4 vs. 60.9 Gy, p < 0.001; IF: 74.3 vs. 70.1 Gy, p < 0.03). With IMRT-IF, a PD of at least 66 Gy was achieved for 95 % of all plans. For IF as compared with ENI, there was a considerable theoretical increase in TCP (IMRT: 27.3 vs. 17.7 %, p < 0.00001; 3D-CRT: 20.2 vs. 9.9 %, p < 0.00001). The esophageal NTCP showed a particularly good sparing with IMRT vs. 3D-CRT (ENI: 12.3 vs. 30.9 % p < 0.0001; IF: 15.9 vs. 24.1 %; p < 0.001).

Conclusion

The IMRT technique and IF target volume delineation allow a significant dose escalation and an increase in TCP. IMRT results in an improved sparing of OARs as compared with 3D-CRT at equivalent dose levels.

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Title: IMRT and 3D conformal radiotherapy with or without elective nodal irradiation in locally advanced NSCLC
A direct comparison of PET-based treatment planning
Authors: Dr. med. Jochen Fleckenstein, MD
Katharina Kremp, MD
Stephanie Kremp, MSc
Jan Palm, MD
Christian Rübe, MD, PhD
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 2/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-015-0900-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

IMRT and 3D conformal radiotherapy with or without elective nodal irradiation in locally advanced NSCLC

A direct comparison of PET-based treatment planning

Abstract

Aim

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Methods

Results

Conclusion

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