PURPOSE: To demonstrate the dosimetric advantages of cardiac-sparing (CS) intensity modulated radiation therapy (IMRT) in children undergoing whole lung irradiation (WLI). METHODS AND MATERIALS: Chest CT scans of 22 children who underwent simulation with 3-dimensional (n=10) or 4-dimensional (n=12) techniques were used for this study. Treatment planning was performed using standard anteroposterior-posteroanterior (S-RT) technique and CS-IMRT. Left and right flank fields were added to WLI fields to determine whether CS-IMRT offered any added protection to normal tissues at the junction between these fields. The radiation dose to the lung PTV, cardiac structures, liver, and thyroid were analyzed and compared. RESULTS: CS-IMRT had 4 significant advantages over S-RT: (1) superior cardiac protection (2) superior 4-dimensional lung planning target volume coverage, (3) superior dose uniformity in the lungs with fewer hot spots, and (4) significantly lower dose to the heart when flank RT is administered after WLI. CONCLUSIONS: The use of CS-IMRT and 4-dimensional treatment planning has the potential to improve tumor control rates and reduce cardiac toxicity in children receiving WLI.
PURPOSE: To demonstrate the dosimetric advantages of cardiac-sparing (CS) intensity modulated radiation therapy (IMRT) in children undergoing whole lung irradiation (WLI). METHODS AND MATERIALS: Chest CT scans of 22 children who underwent simulation with 3-dimensional (n=10) or 4-dimensional (n=12) techniques were used for this study. Treatment planning was performed using standard anteroposterior-posteroanterior (S-RT) technique and CS-IMRT. Left and right flank fields were added to WLI fields to determine whether CS-IMRT offered any added protection to normal tissues at the junction between these fields. The radiation dose to the lung PTV, cardiac structures, liver, and thyroid were analyzed and compared. RESULTS:CS-IMRT had 4 significant advantages over S-RT: (1) superior cardiac protection (2) superior 4-dimensional lung planning target volume coverage, (3) superior dose uniformity in the lungs with fewer hot spots, and (4) significantly lower dose to the heart when flank RT is administered after WLI. CONCLUSIONS: The use of CS-IMRT and 4-dimensional treatment planning has the potential to improve tumor control rates and reduce cardiac toxicity in children receiving WLI.
Authors: John A Kalapurakal; Mahesh Gopalakrishnan; David O Walterhouse; Cynthia K Rigsby; Alfred Rademaker; Irene Helenowski; Sandy Kessel; Karen Morano; Fran Laurie; Ken Ulin; Natia Esiashvili; Howard Katzenstein; Karen Marcus; David S Followill; Suzanne L Wolden; Anita Mahajan; Thomas J Fitzgerald Journal: Int J Radiat Oncol Biol Phys Date: 2018-08-29 Impact factor: 7.038
Authors: James E Bates; Rebecca M Howell; Qi Liu; Yutaka Yasui; Daniel A Mulrooney; Sughosh Dhakal; Susan A Smith; Wendy M Leisenring; Daniel J Indelicato; Todd M Gibson; Gregory T Armstrong; Kevin C Oeffinger; Louis S Constine Journal: J Clin Oncol Date: 2019-03-12 Impact factor: 44.544
Authors: Thomas E Merchant; David Hodgson; Nadia N I Laack; Suzanne Wolden; Danny J Indelicato; John A Kalapurakal Journal: Pediatr Blood Cancer Date: 2012-12-19 Impact factor: 3.167