Restricted field IMRT dramatically enhances IMRT planning for mesothelioma.
OBJECTIVE
To improve the target coverage and normal tissue sparing of intensity-modulated radiotherapy (IMRT) for mesothelioma after extrapleural pneumonectomy.


METHODS
Thirteen plans from patients previously treated with IMRT for mesothelioma were replanned using a restricted field technique. This technique was novel in two ways. It limited the entrance beams to 200 degrees around the target and three to four beams per case had their field apertures restricted down to the level of the heart or liver to further limit the contralateral lung dose. New constraints were added that included a mean lung dose of <9.5 Gy and volume receiving >or=5 Gy of <55%.


RESULTS
In all cases, the planning target volume coverage was excellent, with an average of 97% coverage of the planning target volume by the target dose. No change was seen in the target coverage with the new technique. The heart, kidneys, and esophagus were all kept under tolerance in all cases. The average mean lung dose, volume receiving >or=20 Gy, and volume receiving >or=5 Gy with the new technique was 6.6 Gy, 3.0%, and 50.8%, respectively, compared with 13.8 Gy, 15%, and 90% with the previous technique (p < 0.0001 for all three comparisons). The maximal value for any case in the cohort was 8.0 Gy, 7.3%, and 57.5% for the mean lung dose, volume receiving >or=20 Gy, and volume receiving >or=5 Gy, respectively.


CONCLUSIONS
Restricted field IMRT provides an improved method to deliver IMRT to a complex target after extrapleural pneumonectomy. An upcoming Phase I trial will provide validation of these results.
Allen
Aaron M
AM
Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. aallen@lroc.harvard.edu
Schofield
Deborah
D
Hacker
Fred
F
Court
Laurence E
LE
Czerminska
Maria
M
D006801:Humans; D008654:Mesothelioma / Q000532:radiotherapy* / Q000601:surgery; D010997:Pleural Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011013:Pneumonectomy; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*