The utility of non-axial treatment beam orientations for lower lobe lung cancers

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  • Quaranta, Brian P.
    • Other Affiliation: 21st Century Oncology; Asheville NC
  • Das, Shiva K.
    • Other Affiliation: Department of Radiation Oncology; Duke University Medical Center; Durham NC
  • Shafman, Timothy D.
    • Other Affiliation: 21st Century Oncology; Providence RI
  • Light, Kim L.
    • Other Affiliation: Department of Radiation Oncology; Duke University Medical Center; Durham NC
  • Marks, Lawrence B.
    • School of Medicine, Department of Radiation Oncology
Abstract
  • Purpose: Traditional treatment beams for non-small cell lung cancer are limited to the axial plane. For many tumor geometries non-axial orientations appear to reduce the dose to normal tissues (e.g. heart, liver). We hypothesize that non-axial beams provide a significant reduction in incidental irradiation of the heart and liver, while maintaining adequate target coverage. Materials and Methods: CT scans of twenty-four consecutive patients with lower lobe lung cancers were studied. For each patient, an opposed oblique axial beam pair and a competing non-axial opposed oblique pair were generated. The competing plans delivered comparable doses/margins to the GTV. DVHs and integral doses were computed for all structures of interest for the two competing plans. The integral dose was compared for axial and non-axial beams for each contoured organ using a paired t-test. Results: Dose to the heart was significantly lower for the non-axial plans (p=.0001). For 20/24 patients the integral heart dose was reduced by using non-axial beams. In those patients with tumors located in the inferior right lower lobe, a lower dose to the liver was achieved when non-axial beams were used. There were no meaningful differences in dose to the GTV, lungs, or skin between axial and non-axial beams. Conclusion: Non-axial beams can reduce the dose to the heart and liver in patients with lower lobe lung cancers. Non-axial beams may be clinically beneficial in these patients and should be considered as an option during planning.
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  • Article
Rights statement
  • In Copyright
Journal title
  • Journal of Applied Clinical Medical Physics / American College of Medical Physics
Journal volume
  • 11
Journal issue
  • 1
Page start
  • 128
Page end
  • 136
Language
  • English
ISSN
  • 1526-9914

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