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4DCT radiotherapy for NSCLC: a review of planning methods

Published online by Cambridge University Press:  12 February 2014

A. Hutchinson  and
P. Bridge
A. Hutchinson*
Affiliation:
Radiation Oncology Mater Centre, South Brisbane
P. Bridge
Affiliation:
School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
*
Correspondence to: Adam Glenn Hutchinson, Bachelor of Radiation Therapy, Radiation Oncology Mater Centre, 31 Raymond Terrace, South Brisbane, Australia, 31 Raymond Terrace, Queensland Health, South Brisbane, Queensland, Australia. Tel: (07) 38403244; E-mail: Adam_Hutchinson@health.qld.gov.au
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Abstract

Purpose

To establish whether the use of a passive or active technique of planning target volume (PTV) definition and treatment methods for non-small cell lung cancer (NSCLC) deliver the most effective results. This literature review assesses the advantages and disadvantages in recent studies of each, while assessing the validity of the two approaches for planning and treatment.

Methods

A systematic review of literature focusing on the planning and treatment of radiation therapy to NSCLC tumours. Different approaches which have been published in recent articles are subjected to critical appraisal in order to determine their relative efficacy.

Results

Free-breathing (FB) is the optimal method to perform planning scans for patients and departments, as it involves no significant increase in cost, workload or education. Maximum intensity projection (MIP) is the fastest form of delineation, however it is noted to be less accurate than the ten-phase overlap approach for computed tomography (CT). Although gating has proven to reduce margins and facilitate sparing of organs at risk, treatment times can be longer and planning time can be as much as 15 times higher for intensity modulated radiation therapy (IMRT). This raises issues with patient comfort and stabilisation, impacting on the chance of geometric miss. Stereotactic treatments can take up to 3 hours to treat, along with increases in planning and treatment, as well as the additional hardware, software and training required.

Conclusion

Four-dimensional computed tomography (4DCT) is superior to 3DCT, with the passive FB approach for PTV delineation and treatment optimal. Departments should use a combination of MIP with visual confirmation ensuring coverage for stage 1 disease. Stages 2–3 should be delineated using ten-phases overlaid. Stereotactic and gated treatments for early stage disease should be used accordingly; FB-IMRT is optimal for latter stage disease.

Keywords

computed tomography (CT)delineationfour-dimensional computed tomography (4DCT)free-breathinggatedinternal target volume (ITV)lung cancernon-small cell lung cancer (NSCLC)planning target volume (PTV)radiotherapyradiotherapy planning
Type
Literature Reviews
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 1 , March 2015 , pp. 70 - 79
Copyright
Copyright © Cambridge University Press 2014 

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