title: [Intensity-modulated radiation therapy in non-small cell lung cancers].
abstract: Intensity modulated radiotherapy is increasingly used in non-small-cell lung cancers despite a low level of evidence. A literature review was conducted. Several critical physical and dosimetric uncertainties are however unsolved. Methods to circumvent these limitations are being developed. In several retrospective studies, survival rates were at least similar with intensity-modulated radiotherapy as those reported with three-dimensional irradiation. To date, intensity modulated radiotherapy might be authorized in complex anatomical situations such as tumours close to the spinal cord (such as Pancoast Tobias, paraspinal and paracardiac tumours) or with limited motion amplitudes. Dosimetric benefits should also account for 4D dose distribution issues. The reduction of intermediate and high doses in the organs at risk with intensity modulated radiotherapy is advantageous. However, the effect of low doses in large volumes (lung, bone, unspecified tissues along beam paths) and the effect of increasing integral dose are still poorly known. In conclusion, dose-volume correlations need to be better documented and prospective randomized trials should be encouraged.
authors.affiliation: Service de radiothérapie-physique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France. Electronic address: myriam.ayadi@lyon.unicancer.fr.
authors.forename: M
authors.initials: M
authors.lastname: Ayadi
authors.affiliation: Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France.
authors.forename: N
authors.initials: N
authors.lastname: Zahra
authors.affiliation: Service de radiothérapie, centre Antoine-Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Thariat
authors.affiliation: Service de physique, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: G
authors.initials: G
authors.lastname: Bouilhol
authors.affiliation: Service de radiothérapie-physique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Boissard
authors.affiliation: Département de radiothérapie-oncologie, institut Jules-Bordet, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique.
authors.forename: P
authors.initials: P
authors.lastname: Van Houtte
authors.affiliation: Service de radiothérapie-physique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Claude
authors.affiliation: Département de radiothérapie oncologique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite-Lyon, France; EA 3738, université Claude-Bernard Lyon-1, domaine Rockefeller, 8, avenue Rockefeller, 69373 Lyon cedex 08, France.
authors.forename: F
authors.initials: F
authors.lastname: Mornex
mesh_terms: D016477:Artifacts; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000628:therapy; D059248:Chemoradiotherapy; D016021:Epidemiologic Studies; D004941:Esophagitis / Q000209:etiology / Q000517:prevention & control; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000628:therapy; D009038:Motion; D058958:Organs at Risk; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D017564:Radiation Pneumonitis / Q000209:etiology / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D015656:Respiratory Mechanics; D016896:Treatment Outcome
keywords: Cancers bronchiques non à petites cellules; Contrôle local; Dosimetric uncertainties; IMRT; Incertitudes dosimétriques; Indications potentielles; Local control; NSCLC; Potential indications; RCMI; Toxicities; Toxicité