title: [New techniques and potential benefits for radiotherapy of lung cancer].
abstract: Radiotherapy is used for inoperable lung cancers, sometimes in association with chemotherapy. Outcomes of conventional radiotherapy are disappointing. New techniques improve adaptation to tumour volume, decrease normal tissue irradiation and lead to increasing tumour dose with the opportunity for improved survival. With intensity-modulated radiation therapy, isodoses can conform to complex volumes. It is widely used and seems to be indicated in locally advanced stages. Its dosimetric improvements have been demonstrated but outcomes are still heterogeneous. Stereotactic radiotherapy allows treatment of small volumes with many narrow beams. Dedicated devices or appropriate equipment on classical devices are needed. In early stages, its efficacy is comparable to surgery with an acceptable toxicity. Endobronchial brachytherapy could be used for early stages with specific criteria. Hadrontherapy is still experimental regarding lung cancer. Hadrons have physical properties leading to very accurate dose distribution. In the rare published studies, toxicities are roughly lower than others techniques but for early stages its effectiveness is not better than stereotactic radiotherapy. These techniques are optimized by metabolic imaging which precisely defines the target volume and assesses the therapeutic response; image-guided radiation therapy which allows a more accurate patient set up and by respiratory tracking or gating which takes account of tumour respiratory motions.
authors.affiliation: Département de radiothérapie, centre Henri-Becquerel, rue d'Amiens, 76038 Rouen cedex 1, France. Electronic address: laureline.lefebvre86@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Lefebvre
authors.affiliation: Département de radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Doré
authors.affiliation: Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Paris Cité Sorbonne, 12, rue de l'École-de-Médecine, 75006 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Giraud
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D016021:Epidemiologic Studies; D063193:Heavy Ion Radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000532:radiotherapy* / Q000601:surgery; D015337:Multicenter Studies as Topic; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D061766:Proton Therapy; D017564:Radiation Pneumonitis / Q000209:etiology / Q000517:prevention & control; D019275:Radiopharmaceuticals; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D061089:Radiotherapy, Image-Guided; D035703:Therapies, Investigational / Q000009:adverse effects / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals
keywords: Asservissement respiratoire; Cancer du poumon; Dose painting; Imagerie métabolique; Intensity-modulated radiotherapy; Lung neoplasms; Radiothérapie Stéréotaxique; Radiothérapie conformationnelle par modulation d’intensité; Respiratory gating; Stereotactic body radiotherapy