The influence of lateral electronic disequilibrium on the radiation treatment planning for lung cancer irradiation.

Using higher energy photons can obtain better target dose uniformity and skin sparing for treating deep lesions, but the effect of lacking lateral scattering in the low-density lung may degrade the target coverage. To analyze the influence of lateral electronic disequilibrium on the radiation treatment planning for lung cancer, three dimension conformal treatment (3D-CRT) plans of using 6 MV and 18 MV X-ray respectively for a lung cancer case have been worked out by using pencil beam algorithm and collapsed cone algorithm provided by Helax-TMS treatment planning system for the same radiation field arrangement for both energies. Dose volume histogram (DVH) in target and organs at risk (OARs) are used for comparison of different plans. The study shows that using pencil beam algorithm, the target DVH are similar for 6 MV and 18 MV plan. However, using collapsed cone algorithm that can make account of lateral electron scattering, the target is underdosed. The change is even more pronounced for 18 MV plan. The doses for lung and spinal cord are similar for these two energies and two algorithms. Therefore, for lung cancer, dose calculation algorithm should have the ability of handling accurately the effect of the tissue density heterogeneity. It is better to use the lower-energy photons (6 MV) than to use the higher-energy photons (18 MV).