title: Superior sulcus non-small cell lung carcinoma: A comparison of IMRT and 3D-RT dosimetry.
abstract: OBJECTIVE
  A dosimetric study comparing intensity modulated radiotherapy (IMRT) by TomoTherapy to conformational 3D radiotherapy (3D-RT) in patients with superior sulcus non-small cell lung cancer (NSCLC).
  
  
  BACKGROUND
  IMRT became the main technique in modern radiotherapy. However it was not currently used for lung cancers. Because of the need to increase the dose to control lung cancers but because of the critical organs surrounding the tumors, the gains obtainable with IMRT is not still demonstrated.
  
  
  METHODS
  A dosimetric comparison of the planned target and organs at risk parameters between IMRT and 3D-RT in eight patients who received preoperative or curative intent irradiation.
  
  
  RESULTS
  In the patients who received at least 66 Gy, the mean V95% was significantly better with IMRT than 3D-RT (p = 0.043). IMRT delivered a lower D2% compared to 3D-RT (p = 0.043). The IH was significantly better with IMRT (p = 0.043). The lung V 5 Gy and V 13 Gy were significantly higher in IMRT than 3D-RT (p = 0.043), while the maximal dose (D max) to the spinal cord was significantly lower in IMRT (p = 0.043). The brachial plexus D max was significantly lower in IMRT than 3D-RT (p = 0.048). For patients treated with 46 Gy, no significant differences were found.
  
  
  CONCLUSIONS
  Our study showed that IMRT is relevant for SS-NSCLC. In patients treated with a curative dose, it led to a reduction of the exposure of critical organs, allowing a better dose distribution in the tumor. For the patients treated with a preoperative schedule, our results provide a basis for future controlled trials to improve the histological complete response by increasing the radiation dose.
authors.affiliation: Radiotherapy Department, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 42, 67065 Strasbourg Cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Truntzer
authors.affiliation: Radiotherapy Department, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 42, 67065 Strasbourg Cedex, France; Radiobiology Laboratory EA 3430, Federation of Translational Medicine in Strasbourg (FMTS), Strasbourg University, Strasbourg, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Antoni
authors.affiliation: Thoracic Surgery Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France.
authors.forename: Nicola
authors.initials: N
authors.lastname: Santelmo
authors.affiliation: Thoracic Surgery Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Schumacher
authors.affiliation: Thoracic Surgery Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Pneumology Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Quoix
authors.affiliation: Thoracic Surgery Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Massard
authors.affiliation: Radiotherapy Department, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 42, 67065 Strasbourg Cedex, France; Radiobiology Laboratory EA 3430, Federation of Translational Medicine in Strasbourg (FMTS), Strasbourg University, Strasbourg, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Noël
keywords: Dosimetry; IMRT; Pancoast tumor; Radiotherapy; Superior sulcus NSCLC