ABSTRACT
PURPOSE: To evaluate the effects of beam weight optimization for 3D conformal radiotherapy plans, with or without beam intensity modulation, in Stage III non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: Ten patients with Stage III NSCLC were planned using a conventional 3D technique and a technique involving noncoplanar beam intensity modulation (BIM). Two planning target volumes (PTVs) were defined: PTV1 included macroscopic tumor volume and PTV2 included macroscopic and microscopic tumor volume. Virtual simulation defined the beam shapes and incidences as well as the wedge orientations (3D) and segment outlines (BIM). Weights of wedged beams, unwedged beams, and segments were determined by human trial and error for the 3D-plans (3D-manual), by a standard weight table (SWT) for the BIM-plans (BIM-SWT) and by optimization (3D-optimized and BIM-optimized) using an objective function with a biological and a physical component. The resulting non-optimized and optimized dose distributions were compared, using physical endpoints, after normalizing the median dose of PTV1 to 80 Gy. RESULTS: Optimization improved dose homogeneity at the target for 3D- and BIM-plans and the minimum dose at PTV1. The minimum dose at PTV2 was decreased by optimization especially in 3D-plans. After optimization, the dose-volume histograms (DVHs) of lung and heart were shifted to lower doses for 80-90% of the organ volume. Since lung is the dose-limiting organ in Stage III NSCLC, an increased minimum dose at PTV1 together with a decreased dose at the main lung volume suggests an improved therapeutic ratio. Optimization allows 10% dose escalation for 3D-plans and 20% for BIM-plans at isotoxicity levels of lung and spinal cord. Upon dose escalation, esophagus may become the dose-limiting structure when PTV1 extends close to the esophagus. CONCLUSIONS: Optimization using a biophysical objective function allowed an increase of the therapeutic ratio of radiotherapy planning for Stage III NSCLC.
Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/radiotherapy , Radiotherapy Planning, Computer-Assisted/standards , Radiotherapy, Conformal/standards , Algorithms , Carcinoma, Non-Small-Cell Lung/pathology , Computer Simulation , Esophagus , Heart , Humans , Lung , Lung Neoplasms/pathology , Physical Phenomena , Physics , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted/methods , Spinal CordABSTRACT
PURPOSE: We developed a semiautomatic class solution to irradiate centrally located Stage III non-small cell lung cancer (NSCLC), involving a beam intensity modulation technique and optimization using a biophysical cost function. METHODS AND MATERIALS: Treatment for 10 patients with Stage III NSCLC was planned, using a conventional three- or four-beam three-dimensional (3D) technique and two techniques involving, respectively, seven (BIM1) and five (BIM2) noncoplanar beam incidences with intensity modulation. Two planning target volumes were defined: PTV1 included macroscopic tumor volume and PTV2 included macroscopic and microscopic disease. Beams were divided into beam parts (segments) and their outlines were defined during virtual simulation. Optimization using a biophysical cost function determined beam weights, segment weights, and wedge angles. Biological end points included tumor control probability of both target volumes (TCP1 and TCP2) and normal tissue complication probability (NTCP) of heart, lung, and spinal cord. The resulting uncomplicated local control probability (UCLP) was calculated. Physical end points included dose at PTV1 expressed as a dose minimum and dose maximum. Target-dose inhomogeneity was constrained in all plans. RESULTS: Concerning tumor evaluation, TCP1 was 74% (range 54-89%) for the 3D plan, 78.0% (range 62-94%) for BIM1, and 86.0% (range 59-93%) for BIM2. TCP1*TCP2 was, respectively, 67.0% (range 39-81%), 73.0% (range 56-94%), and 81.0% (range 54-93%). Minimum doses to PTV1 were 85, 80, and 88 Gy with the three respective techniques, while dose maxima were 89, 101, and 100 Gy. NTCPs of lung were 45.0% (range 11-75%) for 3D, 19.5% (range 8-59%) for BIM1, and 24.5% (range 3-61%) for BIM2. NTCPs of heart and spinal cord were comparable for all techniques. ULCPs were 37.0% (range 9-73%), 52.5% (range 22-86%), and 60.0% (range 20-85%), respectively. Applying physical limits to ensure clinical safety, minimum doses at PTV1 were recalculated. These were 72, 71, and 74 Gy for 3D, BIM1, and BIM2, respectively. CONCLUSION: The BIM2 plan is a candidate class solution for dose escalation studies in centrally located Stage III NSCLC.
