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Article Dans Une Revue British Journal of Radiology Année : 2020

Mid-position treatment strategy for locally advanced lung cancer: a dosimetric study

Résumé

Objectives The internal target volume (ITV) strategy generates larger planning target volumes (PTVs) in locally advanced non-small cell lung cancer (LA-NSCLC) than the Mid-position (Mid-p) strategy. We investigated the benefit of the Mid-p strategy regarding PTV reduction and dose to the organs at risk (OARs). Methods 44 patients with LA-NSCLC were included in a randomized clinical study to compare ITV and Mid-p strategies. GTV were delineated by a physician on MIP images and on Mid-p images from four-dimensional CTs. CTVs were obtained by adding 6mm uniform margin for microscopic extension. CTV to PTV margins were calculated using the van Herk's recipe for setup and delineation errors. For the Mid-p strategy, the mean target motion amplitude was added as a random error. For both strategies, 3D conformal plans delivering 60 to 66Gy to PTV were performed. PTVs, dose-volume parameters for OARs (lung, esophagus, heart, spinal cord) were reported and compared. Results With the Mid-p strategy, the median of volume reduction was 23.5cm 3 (p=0.012) and 8.8cm 3 (p=0.0083) for PTVT and PTVN respectively; the median mean lung dose (MLD) reduction was 0.51Gy (p=0.0057). For 37.1% of the patients, delineation errors led to smaller PTV with the ITV strategy than with the Mid-p strategy. Conclusion PTV and MLD were significantly reduced using the Mid-p strategy. Delineation uncertainty can unfavorably impact the advantage. Advances in knowledge To the best of our knowledge, this is the first dosimetric comparison study between ITV and Mid-p strategies for LA-NSCLC. Mid-p strategy significantly reduces tumor, nodal PTVs and MLD. 2
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Dates et versions

hal-02948227 , version 1 (02-10-2020)

Identifiants

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M Ayadi, T. Baudier, G Bouilhol, P Dupuis, P. Boissard, et al.. Mid-position treatment strategy for locally advanced lung cancer: a dosimetric study. British Journal of Radiology, 2020, 93 (1110), pp.20190692. ⟨10.1259/bjr.20190692⟩. ⟨hal-02948227⟩
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