title: Cardiac-sparing whole lung IMRT in children with lung metastasis.
abstract: OBJECTIVE
  To demonstrate the dosimetric advantages of cardiac-sparing (CS) intensity modulated radiation therapy (IMRT) in children undergoing whole lung irradiation (WLI).
  
  
  METHODS
  Chest CT scans of 22 children who underwent simulation with 3-dimensional (n=10) or 4-dimensional (n=12) techniques were used for this study. Treatment planning was performed using standard anteroposterior-posteroanterior (S-RT) technique and CS-IMRT. Left and right flank fields were added to WLI fields to determine whether CS-IMRT offered any added protection to normal tissues at the junction between these fields. The radiation dose to the lung PTV, cardiac structures, liver, and thyroid were analyzed and compared.
  
  
  RESULTS
  CS-IMRT had 4 significant advantages over S-RT: (1) superior cardiac protection (2) superior 4-dimensional lung planning target volume coverage, (3) superior dose uniformity in the lungs with fewer hot spots, and (4) significantly lower dose to the heart when flank RT is administered after WLI.
  
  
  CONCLUSIONS
  The use of CS-IMRT and 4-dimensional treatment planning has the potential to improve tumor control rates and reduce cardiac toxicity in children receiving WLI.
authors: Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA. j-kalapurakal@northwestern.edu
authors: John A
authors: JA
authors: Kalapurakal
authors: Yunkai
authors: Y
authors: Zhang
authors: Alan
authors: A
authors: Kepka
authors: Brian
authors: B
authors: Zawislak
authors: Vythialingam
authors: V
authors: Sathiaseelan
authors: Cynthia
authors: C
authors: Rigsby
authors: Mahesh
authors: M
authors: Gopalakrishnan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D056973:Four-Dimensional Computed Tomography / Q000379:methods; D006321:Heart / Q000000981:diagnostic imaging / Q000528:radiation effects*; D006801:Humans; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D059351:Organ Sparing Treatments / Q000379:methods*; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000528:radiation effects*; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013961:Thyroid Gland / Q000000981:diagnostic imaging