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The dosimetric effects of limited elective nodal irradiation in volumetric modulated arc therapy treatment planning for locally advanced non-small cell lung cancer

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Contemporary radiotherapy guidelines for locally advanced non-small cell lung carcinoma (LA-NSCLC) recommend omitting elective nodal irradiation, despite the fact that evidence supporting this came primarily from older reports assessing comprehensive nodal coverage using 3D conformal techniques. Herein, we evaluated the dosimetric implications of the addition of limited elective nodal irradiation (LENI) to standard involved field irradiation (IFI) using volumetric modulated arc therapy (VMAT) planning.

Method

Target volumes and organs-at-risk (OARs) were delineated on CT simulation images of 20 patients with LA-NSCLC. Two VMAT plans (IFI and LENI) were generated for each patient. Involved sites were treated to 60 Gy in 30 fractions for both IFI and LENI plans. Adjacent uninvolved nodal regions, considered high risk based on the primary tumor site and extent of nodal involvement, were treated to 51 Gy in 30 fractions in LENI plans using a simultaneous integrated boost approach.

Results

All planning objectives for PTVs and OARs were achieved for both IFI and LENI plans. LENI resulted in significantly higher esophagus D mean (15.3 vs. 22.5 Gy, p < 0.01), spinal cord D max (34.9 vs. 42.4 Gy, p = 0.02) and lung D mean (13.5 vs. 15.9 Gy, p = 0.02), V 20 (23.0 vs. 27.9%, p = 0.03), and V 5 (52.6 vs. 59.4%, p = 0.02). No differences were observed in heart parameters. On average, only 32.2% of the high-risk nodal volume received an incidental dose of 51 Gy when untargeted in IFI plans.

Conclusion

The addition of LENI to VMAT plans for LA-NSCLC is feasible, with only modestly increased doses to OARs and marginal expected increase in associated toxicity.

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Acknowledgements

We thank Brenda Darnell, Brenda Maxwell, and Robert Bice for teaching and assisting in dosimetric planning and calculations, as well as the West Virginia University Initiation to Research Opportunities (INTRO) Summer Research Program for their support.

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Correspondence to Malcolm D. Mattes.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Statement of informed consent was not applicable since the manuscript does not contain any patient data.

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Kenamond, M.C., Alfredo Siochi, R. & Mattes, M.D. The dosimetric effects of limited elective nodal irradiation in volumetric modulated arc therapy treatment planning for locally advanced non-small cell lung cancer. J Radiat Oncol 7, 45–51 (2018). https://doi.org/10.1007/s13566-017-0327-2

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