title: Combined photon and electron three-dimensional conformal versus intensity-modulated radiotherapy with integrated boost for adjuvant treatment of malignant pleural mesothelioma after pleuropneumonectomy.
abstract: OBJECTIVE
  The optimal technique for postoperative radiotherapy (RT) after extrapleural pleuropneumonectomy (EPP) of malignant pleural mesothelioma (MPM) remains debated.
  
  
  METHODS
  The data from 8 right-sided and 9 left-sided consecutive cases of MPM treated with RT after radical EPP were reviewed. Of the 17 patients, 8 had been treated with three-dimensional (3D) conformal RT (3D-CRT) and 9 with intensity-modulated RT (IMRT) with 6-MV photons. The clinical outcome and adverse events were assessed. For comparative planning, each case was replanned with 3D-CRT using photons and electrons or with IMRT. Homogeneity, doses to the organs at risk, and target volume coverage were analyzed.
  
  
  RESULTS
  Both techniques yielded acceptable plans. The dose coverage and homogeneity of IMRT increased by 7.7% for the first planning target volume and 9.7% for the second planning target volume, ensuring >or=95% of the prescribed dose compared with 3D-CRT (p < 0.01). Compared with 3D-CRT, IMRT increased the dose to the contralateral lung, with an increase in the mean lung dose of 7.8 Gy and an increase in the volume receiving 13 Gy and 20 Gy by 20.5% and 7.2%, respectively (p < 0.01). A negligible dose increase to the contralateral kidney and liver was observed. No differences were seen for the spinal cord and ipsilateral kidney. Two adverse events of clinical relevant lung toxicity were observed with IMRT.
  
  
  CONCLUSIONS
  Intensity-modulated RT and 3D-CRT are both suitable for adjuvant RT. IMRT improves the planning target volume coverage but delivered greater doses to the organs at risk. Rigid dose constraints for the lung should be respected.
authors.affiliation: Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Jerôme
authors.initials: J
authors.lastname: Krayenbuehl
authors.forename: Susanne
authors.initials: S
authors.lastname: Oertel
authors.forename: J Bernard
authors.initials: JB
authors.lastname: Davis
authors.forename: I Frank
authors.initials: IF
authors.lastname: Ciernik
mesh_terms: D000368:Aged; D005260:Female; D006321:Heart; D006801:Humans; D007668:Kidney; D008168:Lung; D008297:Male; D008654:Mesothelioma / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D010994:Pleura / Q000601:surgery; D010997:Pleural Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011013:Pneumonectomy / Q000379:methods; D017564:Radiation Pneumonitis / Q000150:complications; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies