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Intensity-Modulated Radiation Therapy and Volumetric Modulated Arc Therapy for Lung Cancer

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Advances in Radiation Oncology in Lung Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

Per 2021 American Cancer Society estimates, lung cancer has the second highest incidence and highest mortality of all malignancies in the United States. Outcomes have improved considerably over the past decade, with radiation therapy (RT) serving as a cornerstone of locoregional therapy. The technical challenges of delivering biologically effective doses of RT capable of achieving local control include accurate target definition and accounting for respiratory tumor motion, tissue heterogeneities, and normal tissue tolerance. Three-dimensional conformal radiation therapy (3D CRT) is now the minimum technical standard for treating NSCLC. Intensity-modulated radiation therapy (IMRT) and volumetrically modulated radiation therapy (VMAT), in addition to four-dimensional (4D) CT simulation and planning techniques, biological targeting via positron emission tomography (PET), and 2D and 3D image-guided delivery methods, have facilitated radiation dose escalation while respecting normal tissue tolerance of organs at risk (OAR). In patients with locally advanced disease, IMRT has demonstrated improved dosimetric and toxicity profiles when compared to 3D CRT. However, this comes at the cost of long treatment times and high integral dose. With improvements in commercial planning software and quality assurance measures, VMAT is now commonly employed to achieve the improved conformality found with IMRT along with shorter treatment times and fewer monitor units delivered. Though no randomized trials comparing 3D CRT to IMRT/VMAT have been performed, these advanced modalities should be strongly considered in patients with locally advanced disease.

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Notes

  1. 1.

    For the purposes of this chapter, the abbreviation “IMRT” by default will henceforth refer only to fixed-field IMRT, whereby intensity-modulated beams are delivered from multiple discrete, fixed angles (using segmental or dynamic MLCs) without any gantry rotation during beam-on time, thus excluding techniques such as tomotherapy, IMAT, and VMAT. The unabbreviated term “intensity-modulated radiation therapy” may, however, confer a broader connotation.

  2. 2.

    Notably, distinctions for IMAT and VMAT are not universally agreed upon. The term “arc therapy” will refer both to IMAT and VMAT. As the term “VMAT” corresponds to technological advances of IMAT, Yu et al. refer to VMAT expressly as IMAT. Further, VMAT technology has been trademarked with Elekta (VMAT™), Varian (RapidArc™), and Philips (SmartArc™) and has also been referred to as “arc-modulated radiation therapy” (AMRT). Henceforth, the terms “volumetric modulated arc therapy” and “VMAT” will refer generically to the advanced IMAT technology inclusive of variable gantry velocity and variable dose rate and exclusive of arc therapy delivered with uniform dose rate and uniform gantry velocity, which will be referred to as intensity-modulated arc therapy or “IMAT.” Furthermore, tomotherapy will be considered as its own modality (not to be incorporated by default with the terms “IMRT,” “arc therapy,” “IMAT,” or “VMAT”).

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  1. Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA

    Jacob S. Parzen & Inga S. Grills

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  1. Jacob S. Parzen
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  2. Inga S. Grills
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Correspondence to Inga S. Grills .

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  1. School of Medicine, University of Kragujevac, Kragujevac, Serbia

    Branislav Jeremić

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Parzen, J.S., Grills, I.S. (2022). Intensity-Modulated Radiation Therapy and Volumetric Modulated Arc Therapy for Lung Cancer. In: Jeremić, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2022_340

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