title: Evaluating target coverage and normal tissue sparing in the adjuvant radiotherapy of malignant pleural mesothelioma: helical tomotherapy compared with step-and-shoot IMRT.
abstract: OBJECTIVE
  To evaluate the potential of helical tomotherapy in the adjuvant treatment of malignant pleural mesothelioma and compare target homogeneity, conformity and normal tissue dose with step-and-shoot intensity-modulated radiotherapy.
  
  
  METHODS
  Ten patients with malignant pleural mesothelioma who had undergone neoadjuvant chemotherapy with cisplatin and permetrexed followed by extrapleural pneumonectomy (EPP) were treated in our department with 54 Gy to the hemithorax delivered by step-and-shoot IMRT. A planning comparison was performed by creating radiation plans for helical tomotherapy. The different plans were compared by analysing target homogeneity using the homogeneity indices HI(max) and HI(min) and target conformity by using the conformity index CI(95). To assess target coverage and normal tissue sparing TV(90), TV(95) and mean and maximum doses were compared.
  
  
  RESULTS
  Both modalities achieved excellent dose distributions while sparing organs at risk. Target coverage and homogeneity could be increased significantly with helical tomotherapy compared with step-and-shoot IMRT. Mean dose to the contralateral lung could be lowered beyond 5 Gy.
  
  
  CONCLUSIONS
  Our planning study showed that helical tomotherapy is an excellent option for the adjuvant intensity-modulated radiotherapy of MPM. It is capable of improving target coverage and homogeneity.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Germany. florian.sterzing@med.uni-heidelberg.de
authors.forename: Florian
authors.initials: F
authors.lastname: Sterzing
authors.forename: Gabriele
authors.initials: G
authors.lastname: Sroka-Perez
authors.forename: Kai
authors.initials: K
authors.lastname: Schubert
authors.forename: Marc W
authors.initials: MW
authors.lastname: Münter
authors.forename: Christian
authors.initials: C
authors.lastname: Thieke
authors.forename: Peter
authors.initials: P
authors.lastname: Huber
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Klaus K
authors.initials: KK
authors.lastname: Herfarth
mesh_terms: D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome