Dosimetric comparison of four radiotherapy techniques for stage III non‑small cell lung cancer

Li,Chao; Luo,Haifeng; Song,Wenli; Hu,Yan; Li,Jingjing; Cai,Zhiqiang

doi:10.3892/ol.2023.13933

August-2023 Volume 26 Issue 2

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

August-2023 Volume 26 Issue 2

Full Size Image

Article Open Access

Dosimetric comparison of four radiotherapy techniques for stage III non‑small cell lung cancer

Authors:
- Chao Li
- Haifeng Luo
- Wenli Song
- Yan Hu
- Jingjing Li
- Zhiqiang Cai
View Affiliations / Copyright

Affiliations: Department of Radiotherapy, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China, Department of Oncology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China

Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 347
|
Published online on: June 27, 2023

https://doi.org/10.3892/ol.2023.13933
Expand metrics +

Abstract

The present study was implemented to compare the dosimetric parameters of the target dose coverage and critical structures in the treatment planning of four radiotherapy techniques [namely, three‑dimensional conformal radiation therapy (3D‑CRT), intensity‑modulated radiation therapy (IMRT), hybrid IMRT (h‑IMRT) and volumetric‑modulated arc therapy (VMAT)] for stage III non‑small cell lung cancer (NSCLC) qualified plans for medical physicists, therapists and physicians. A total of 40 patients confirmed to have stage IIIA or IIIB NSCLC were enrolled, and four plans were designed for each patient. The prescription dose to the planning target volume (PTV) was assigned as 60 Gy in 30 fractions. The conformity index (CI), heterogeneity index (HI) and parameters of organs at risk (OARs) were calculated. For the PTV, the CI for VMAT was found to be the highest of all the four techniques (P<0.05), whereas the HI for the h‑IMRT technique was found to be the lowest (P<0.05). Concerning the OARs, for the percentage of lung volume receiving a dose >5 Gy (lung V₅), the highest value was obtained with VMAT (P<0.05), whereas for lung V₃₀ and heart V₃₀, the VMAT and IMRT techniques were found to be better compared with 3D‑CRT and h‑IMRT (P<0.05). For esophagus V₅₀, the maximal dose (Dmax) and mean dose for the IMRT technique displayed the best results (P<0.05), and in the case of the spinal cord, the Dmax with VMAT showed a significant advantage over the other techniques (P<0.05). The treatment monitor units (MUs) in IMRT were found to be the largest (P<0.05), whereas the treatment time with VMAT was the shortest (P<0.05). For smaller PTVs, VMAT was the technique that provided the optimal dose distribution and sparing of the heart. Compared with 3D‑CRT alone, adding 20% IMRT to the 3D‑CRT base plan was shown to improve the plan quality, and IMRT and VMAT, as techniques, had better dose coverage and sparing of OARs. Furthermore, for patients in whom the lung V5 could be kept low enough, VMAT potentially offered a good alternative to the technique to IMRT, thereby offering additional possibilities for sparing of other OARs, and decreasing the MUs and treatment time.

View Figures

View References

1	Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A and Bray F: Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 71:209–249. 2021. View Article : Google Scholar : PubMed/NCBI
2	Conibear J; AstraZeneca UK Limited, : Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer. Br J Cancer. 123 (Suppl 1):S10–S17. 2020. View Article : Google Scholar
3	Punnett G, Fenemore J, Blackhall F and Yorke J: Support and information needs for patients with non-small cell lung cancer receiving concurrent chemo-radiotherapy treatment with curative intent: Findings from a qualitative study. Eur J Oncol Nurs. 64:1023252023. View Article : Google Scholar : PubMed/NCBI
4	Kao J, Farrugia MK, Frontario S, Zucker A, Copel E, Loscalzo J, Sangal A, Darakchiev B, Singh A and Missios S: Association of radiation dose intensity with overall survival in patients with distant metastases. Cancer Med. 10:7934–7942. 2021. View Article : Google Scholar : PubMed/NCBI
5	Alterio D, Gugliandolo SG, Augugliaro M, Marvaso G, Gandini S, Bellerba F, Russell-Edu SW, Simone ID, Cinquini M, Starzyńska A, et al: IMRT versus 2D/3D conformal RT in oropharyngeal cancer: A review of the literature and meta-analysis. Oral Dis. 27:1644–1653. 2021. View Article : Google Scholar : PubMed/NCBI
6	Faye MD and Alfieri J: Advances in radiation oncology for the treatment of cervical cancer. Curr Oncol. 29:928–944. 2022. View Article : Google Scholar : PubMed/NCBI
7	Xu Y, Deng W, Yang S, Li P, Kong Y, Tian Y, Liao Z and Chen M: Dosimetric comparison of the helical tomotherapy, volumetric-modulated arc therapy and fixed-field intensity-modulated radiotherapy for stage IIB-IIIB non-small cell lung cancer. Sci Rep. 7:148632017. View Article : Google Scholar : PubMed/NCBI
8	Zhang Y, Han A, Fu Z, Xu S and Zhang Z: The dosimetric comparisons of CRT, IMRT, ARC, CRT+IMRT, and CRT+ARC of postoperative radiotherapy in IIIA-N2 stage non-small-cell lung cancer patients. Biomed Res Int. 2019:89892412019.PubMed/NCBI
9	Shrimali R, Chakraborty S, Bhattacharyya T, Mallick I, Achari RB, Prasath S, Arun B, Mahata A, Shree MV, Vishnupriya E and Chatterjee S: Development and validation of a decision support tool to select IMRT as radiotherapy treatment planning modality for patients with locoregionally advanced non-small cell lung cancers (NSCLC). Br J Radiol. 92:201804312019. View Article : Google Scholar : PubMed/NCBI
10	Truntzer P, Antoni D, Santelmo N, Schumacher C, Falcoz PE, Quoix E, Massard G and Noël G: Superior sulcus non-small cell lung carcinoma: A comparison of IMRT and 3D-RT dosimetry. Rep Pract Oncol Radiother. 21:427–434. 2016. View Article : Google Scholar : PubMed/NCBI
11	Khalil AA, Hoffmann L, Moeller DS, Farr KP and Knap MM: New dose constraint reduces radiation-induced fatal pneumonitis in locally advanced non-small cell lung cancer patients treated with intensity-modulated radiotherapy. Acta Oncol. 54:1343–1349. 2015. View Article : Google Scholar : PubMed/NCBI
12	Otto K: Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys. 35:310–317. 2008. View Article : Google Scholar : PubMed/NCBI
13	Li Y, Wang J, Tan L, Hui B, Ma X, Yan Y, Xue C, Shi X, Drokow EK and Ren J: Dosimetric comparison between IMRT and VMAT in irradiation for peripheral and central lung cancer. Oncol Lett. 15:3735–3745. 2018.PubMed/NCBI
14	Pokhrel D, Sanford L, Halfman M and Molloy J: Potential reduction of lung dose via VMAT with jaw tracking in the treatment of single-isocenter/two-lesion lung SBRT. J Appl Clin Med Phys. 20:55–63. 2019. View Article : Google Scholar : PubMed/NCBI
15	Iqbal MS, Richmond N, Ogilvie A, Pilling K, Willis N, Byrne J, Walker C and West N: Dosimetric evaluation of VMAT for palliative radiotherapy for non-small cell lung carcinoma. Br J Radiol. 91:201801462018. View Article : Google Scholar : PubMed/NCBI
16	Osborn J: Is VMAT beneficial for patients undergoing radiotherapy to the head and neck? Radiography (Lond). 23:73–76. 2017. View Article : Google Scholar : PubMed/NCBI
17	Hunte SO, Clark CH, Zyuzikov N and Nisbet A: Volumetric modulated arc therapy (VMAT): A review of clinical outcomes-what is the clinical evidence for the most effective implementation? Br J Radiol. 95:202012892022. View Article : Google Scholar : PubMed/NCBI
18	Verbakel WF, van Reij E, Ladenius-Lischer I, Cuijpers JP, Slotman BJ and Senan S: Clinical application of a novel hybrid intensity-modulated radiotherapy technique for stage III lung cancer and dosimetric comparison with four other techniques. Int J Radiat Oncol Biol Phys. 83:e297–e303. 2012. View Article : Google Scholar : PubMed/NCBI
19	Schwartz LH, Litière S, de Vries E, Ford R, Gwyther S, Mandrekar S, Shankar L, Bogaerts J, Chen A, Dancey J, et al: RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer. 62:132–137. 2016. View Article : Google Scholar : PubMed/NCBI
20	Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR and Winchester DP: The eighth edition AJCC cancer staging manual: Continuing to build a bridge from a population-based to a more ‘personalized’ approach to cancer staging. CA Cancer J Clin. 67:93–99. 2017. View Article : Google Scholar : PubMed/NCBI
21	Hodapp N: The ICRU Report 83: Prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlenther Onkol. 188:97–99. 2012.(In German). View Article : Google Scholar : PubMed/NCBI
22	Haslett K, Bayman N, Franks K, Groom N, Harden SV, Harris C, Hanna G, Harrow S, Hatton M, McCloskey P, et al: Isotoxic intensity modulated radiation therapy in stage III non-small cell lung cancer: A feasibility study. Int J Radiat Oncol Biol Phys. 109:1341–1348. 2021. View Article : Google Scholar : PubMed/NCBI
23	Ma C, Tian Z, Wang R, Feng Z, Jiang F, Hu Q, Yang F, Shi A and Wu H: A prediction model for dosimetric-based lung adaptive radiotherapy. Med Phys. 49:6319–6333. 2022. View Article : Google Scholar : PubMed/NCBI
24	Kim JP, Dewalt J, Feldman A, Adil K, Movsas B and Chetty IJ: Feasibility of radical cardiac-sparing, treatment planning strategies for patients with locally advanced, non-small cell lung cancer. J Appl Clin Med Phys. 23:e137842022. View Article : Google Scholar : PubMed/NCBI
25	McKenzie E, Zhang S, Zakariaee R, Guthier CV, Hakimian B, Mirhadi A, Kamrava M, Padda SK, Lewis JH, Nikolova A, et al: Left anterior descending coronary artery radiation dose association with all-cause mortality in NRG oncology trial RTOG 0617. Int J Radiat Oncol Biol Phys. 115:1138–1143. 2023. View Article : Google Scholar : PubMed/NCBI
26	Kataria T, Sharma K, Subramani V, Karrthick KP and Bisht SS: Homogeneity Index: An objective tool for assessment of conformal radiation treatments. J Med Phys. 37:207–213. 2012. View Article : Google Scholar : PubMed/NCBI
27	Paddick I: A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg. 93 (Suppl 3):S219–S222. 2000. View Article : Google Scholar : PubMed/NCBI
28	Guillemin F, Berger L, Lapeyre M and Bellière-Calandry A: Dosimetric and toxicity comparison of IMRT and 3D-CRT of non-small cell lung cancer. Cancer Radiother. 25:747–754. 2021.(In French). View Article : Google Scholar : PubMed/NCBI
29	Peng J, Pond G, Donovan E, Ellis PM and Swaminath A: A comparison of radiation techniques in patients treated with concurrent chemoradiation for stage III non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 106:985–992. 2020. View Article : Google Scholar : PubMed/NCBI
30	Jang SS, Shin Y, Park SY, Huh GJ and Yang YJ: Impact of tumor size and location on lung dose difference between stereotactic body radiation therapy techniques for non-small cell lung cancer. Thorac Cancer. 12:3310–3318. 2021. View Article : Google Scholar : PubMed/NCBI
31	Livingston GC, Last AJ, Shakespeare TP, Dwyer PM, Westhuyzen J, McKay MJ, Connors L, Leader S and Greenham S: Toxicity and dosimetric analysis of non-small cell lung cancer patients undergoing radiotherapy with 4DCT and image-guided intensity modulated radiotherapy: A regional centre's experience. J Med Radiat Sci. 63:170–178. 2016. View Article : Google Scholar : PubMed/NCBI
32	Bradley JD, Hu C, Komaki RR, Masters GA, Blumenschein GR, Schild SE, Bogart JA, Forster KM, Magliocco AM, Kavadi VS, et al: Long-term results of NRG oncology RTOG 0617: Standard- Versus high-dose chemoradiotherapy with or without cetuximab for unresectable stage III non-small-cell lung cancer. J Clin Oncol. 38:706–714. 2020. View Article : Google Scholar : PubMed/NCBI
33	Bradley JD, Paulus R, Komaki RR, Masters G, Blumenschein G, Schild S, Bogart J, Hu C, Forster K, Magliocco A, et al: Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): A randomised, two-by-two factorial phase 3 study. Lancet Oncol. 16:187–199. 2015. View Article : Google Scholar : PubMed/NCBI
34	Boonyawan K, Gomez DR, Komaki R, Xu Y, Nantavithya C, Allen PK, Mohan R and Liao Z: Clinical and dosimetric factors predicting grade ≥2 radiation pneumonitis after postoperative radiotherapy for patients with non-small cell lung carcinoma. Int J Radiat Oncol Biol Phys. 101:919–926. 2018. View Article : Google Scholar : PubMed/NCBI
35	Tonison JJ, Fischer SG, Viehrig M, Welz S, Boeke S, Zwirner K, Klumpp B, Braun LH, Zips D and Gani C: Radiation pneumonitis after intensity-modulated radiotherapy for esophageal cancer: Institutional data and a systematic review. Sci Rep. 9:22552019. View Article : Google Scholar : PubMed/NCBI
36	Lewis GD, Agrusa JE, Teh BS, Gramatges MM, Kothari V, Allen CE and Paulino AC: Radiation pneumonitis in pediatric Hodgkin lymphoma patients receiving radiation therapy to the chest. Pract Radiat Oncol. 8:e364–e368. 2018. View Article : Google Scholar : PubMed/NCBI
37	Grambozov B, Wolf F, Kaiser J, Wass R, Fastner G, Gaisberger C, Rettenbacher L, Studnicka M, Pirich C, Sedlmayer F and Zehentmayr F: Pulmonary function decreases moderately after accelerated high-dose irradiation for stage III non-small cell lung cancer. Thorac Cancer. 11:369–378. 2019. View Article : Google Scholar : PubMed/NCBI
38	Chang JY: Intensity-modulated radiotherapy, not 3 dimensional conformal, is the preferred technique for treating locally advanced lung cancer. Semin Radiat Oncol. 25:110–116. 2015. View Article : Google Scholar : PubMed/NCBI
39	Atkins KM, Bitterman DS, Chaunzwa TL, Williams CL, Rahman R, Kozono DE, Baldini EH, Aerts HJW, Tamarappoo BK, Hoffmann U, et al: Statin use, heart radiation dose, and survival in locally advanced lung cancer. Pract Radiat Oncol. 11:e459–e467. 2021. View Article : Google Scholar : PubMed/NCBI
40	Łazar-Poniatowska M, Kamińska J, Konopa K, Dziadziuszko R and Jassem J: Contralateral esophageal sparing technique in definitive radiotherapy for non-small cell lung cancer: Dosimetric parameters and normal tissue complication probability modeling. Rep Pract Oncol Radiother. 27:933–942. 2022. View Article : Google Scholar : PubMed/NCBI
41	Schultheiss TE, Kun LE, Ang KK and Stephens LC: Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys. 31:1093–1112. 1995. View Article : Google Scholar : PubMed/NCBI
42	Sakthivel V, Mani GK, Mani S and Boopathy R: Radiation-induced second cancer risk from external beam photon radiotherapy for head and neck cancer: Impact on in-field and out-of-field organs. Asian Pac J Cancer Prev. 18:1897–1903. 2017.PubMed/NCBI
43	Fjellanger K, Rossi L, Heijmen BJM, Pettersen HES, Sandvik IM, Breedveld S, Sulen TH and Hysing LB: Patient selection, inter-fraction plan robustness and reduction of toxicity risk with deep inspiration breath hold in intensity-modulated radiotherapy of locally advanced non-small cell lung cancer. Front Oncol. 12:9661342022. View Article : Google Scholar : PubMed/NCBI
44	Guberina M, Santiago A, Pöttgen C, Indenkämpen F, Lübcke W, Qamhiyeh S, Gauler T, Hoffmann C, Guberina N and Stuschke M: Respiration-controlled radiotherapy in lung cancer: Systematic evaluation of the optimal application practice. Clin Transl Radiat Oncol. 40:1006282023. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Dosimetric comparison of four radiotherapy techniques for stage III non‑small cell lung cancer

This article is mentioned in:

Abstract

Figure 1

Figure 2

Figure 3

Related Articles