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Intensity-modulated radiotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma after extrapleural pleuropneumonectomy.
MedLine Citation:
PMID:  23835378     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Radiotherapy reduces the local relapse rate after pleuropneumonectomy of malignant pleural mesothelioma (MPM). The optimal treatment technique with photons remains undefined. Comparative planning for intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) was performed. Six MPM patients with significant postoperative intrathoracic air cavities were planned with IMRT and VMAT. A dose comparison for the targets and organ at risks (OAR) was performed. Robustness was assessed in respect to the variation of target dose with change in volume of air cavities. VMAT reduced the dose to the contralateral lung by reducing the volume covered by 13 Gy and 20 Gy by a factor 1.8 and 2.8, in respect to IMRT (p = 0.02). Dose distribution with VMAT was the most stable technique in regard to postsurgical air cavity variation. For IMRT, V90, V95, and the minimal target dose decreased by 40%, 64%, and 12% compared to 29%, 47%, and 7% with VMAT when air cavity decreased. Two arcs compared to one arc decreased the dose to all the organs at risk (OAR) while leaving PTV dose coverage unchanged. Increasing the number of arcs from two to three did not reduce the dose to the OAR further, but increased the beam-on time by 50%. Using partial arcs decreased the beam-on time by 43%. VMAT allows a lower lung dose and is less affected by the air cavity variation than IMRT. The best VMAT plans were obtained with two partial arcs. VMAT seems currently the most suitable technique for the treatment of MPM patients when air cavities are remaining and no adaptive radiotherapy is performed.
Authors:
Jerome Krayenbuehl; Oliver Riesterer; Shaun Graydon; Peter Dimmerling; Stephan Kloeck; Ilja F Ciernik
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Publication Detail:
Type:  Journal Article     Date:  2013-07-08
Journal Detail:
Title:  Journal of applied clinical medical physics / American College of Medical Physics     Volume:  14     ISSN:  1526-9914     ISO Abbreviation:  J Appl Clin Med Phys     Publication Date:  2013  
Date Detail:
Created Date:  2013-07-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101089176     Medline TA:  J Appl Clin Med Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4130     Citation Subset:  IM    
Affiliation:
University Hospital Zurich. jerome.krayenbuehl@usz.ch.
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