title: Toxicity and dosimetric analysis of non-small cell lung cancer patients undergoing radiotherapy with 4DCT and image-guided intensity modulated radiotherapy: a regional centre's experience.
abstract: BACKGROUND
  For patients receiving radiotherapy for locally advance non-small cell lung cancer (NSCLC), the probability of experiencing severe radiation pneumonitis (RP) appears to rise with an increase in radiation received by the lungs. Intensity modulated radiotherapy (IMRT) provides the ability to reduce planned doses to healthy organs at risk (OAR) and can potentially reduce treatment-related side effects. This study reports toxicity outcomes and provides a dosimetric comparison with three-dimensional conformal radiotherapy (3DCRT).
  
  
  METHODS
  Thirty curative NSCLC patients received radiotherapy using four-dimensional computed tomography and five-field IMRT. All were assessed for early and late toxicity using common terminology criteria for adverse events. All plans were subsequently re-planned using 3DCRT to the same standard as the clinical plans. Dosimetric parameters for lungs, oesophagus, heart and conformity were recorded for comparison between the two techniques.
  
  
  RESULTS
  IMRT plans achieved improved high-dose conformity and reduced OAR doses including lung volumes irradiated to 5-20 Gy. One case each of oesophagitis and erythema (3%) were the only Grade 3 toxicities. Rates of Grade 2 oesophagitis were 40%. No cases of Grade 3 RP were recorded and Grade 2 RP rates were as low as 3%.
  
  
  CONCLUSIONS
  IMRT provides a dosimetric benefit when compared to 3DCRT. While the clinical benefit appears to increase with increasing target size and increasing complexity, IMRT appears preferential to 3DCRT in the treatment of NSCLC.
authors.affiliation: Port Macquarie Base Hospital Port Macquarie NSW Australia.
authors.forename: Gareth C
authors.initials: GC
authors.lastname: Livingston
authors.affiliation: Port Macquarie Base Hospital Port Macquarie NSW Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Last
authors.affiliation: Coffs Harbour Health Campus Coffs Harbour NSW Australia.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shakespeare
authors.affiliation: Lismore Base Hospital Lismore NSW Australia.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Dwyer
authors.affiliation: Coffs Harbour Health Campus Coffs Harbour NSW Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Westhuyzen
authors.affiliation: Lismore Base Hospital Lismore NSW Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McKay
authors.affiliation: Lismore Base Hospital Lismore NSW Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Connors
authors.affiliation: Coffs Harbour Health Campus Coffs Harbour NSW Australia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Leader
authors.affiliation: Coffs Harbour Health Campus Coffs Harbour NSW Australia.
authors.forename: Stuart
authors.initials: S
authors.lastname: Greenham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D004890:Erythema / Q000209:etiology; D004941:Esophagitis / Q000209:etiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods / Q000592:standards
keywords: Four‐dimensional computed tomography; image‐guided radiotherapy; intensity modulated radiotherapy; non–small cell lung cancer