Does the IMRT technique allow improvement of treatment plans (e.g. lung sparing) for lung cancer patients with small lung volume: a planning study

SUMMARY AIM: We evaluated whether intensity-modulated radiation therapy ( iMRt ) may offer any advantages in comparison with three-dimensional conformal radiotherapy (3D-CRT) for patients with small lung volume (S lV). METHODS: Treatment planning was performed for 10 NSCLC patients with the smallest lung volume (mean: 2241 cc) among 200 patients from our database. For each patient 3D-CRT and IMRT plans were prepared. The goal was to deliver 66 Gy/33 fractions, with dose constraints: mean lung dose (MLD)<20Gy, V20<35%; spinal cord – Dmax <45 Gy. When the plan could not meet these criteria, total dose was reduced. The 3D-CRT and IMRT plans were compared. We investigated: prescribed dose, coverage and conformity indices, MLD, V5-V65 in the lung. RESULTS: In 4 out of 10 plans, 3D-CRT did not allow 66 Gy to be delivered, because of predicted pulmonary toxicity. These 4 cases included 3 for which we did not reach 66 Gy with IMRT; still, for these 3 plans the total dose was increased by an average of 9 Gy with IMRT in comparison with 3D-CRT. Coverage indices were similar for both techniques. Conformity indices were better for IMRT plans. MLD was lower in five IMRT and two 3D-CRT plans if equal doses were delivered. The decrease in MLD was seen for cases with large PTV and high PTV/lung volume ratio. Lung V5 was lower for all 3D-CRT plans, 47% vs. 57% for IMRT; V15 and above were larger for 3D-CRT CONCLUSION: In the planning study, IMRT seems to be a promising technique for cases with SLV, especially when associated with large pt V.