Abstract
Lung cancer is still the most frequent malignancy around the world, and radiotherapy together with surgery and systemic therapy is a key modality in the curative treatment of both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Due to modern effective screening and staging methods, the selection of patients with curative treatment options has improved. In times of increasingly precise radiotherapy techniques, accurate target and normal tissue delineation belong to the tools which guarantee the maximum chance of long-term survival along with acceptable side effects. Systematic errors, introduced by incorrect delineation of GTV (gross tumour volume), CTV (clinical target volume), necessary margins and normal tissues, will significantly reduce the probability of local tumour control and normal tissue sparing.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Auperin A, Le Pechoux C, Rolland E et al (2010) Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 28:2181–2190
Baba F, Shibamoto Y, Tomita N et al (2009) Stereotactic body radiotherapy for stage I lung cancer and small lung metastasis: evaluation of an immobilization system for suppression of respiratory tumor movement and preliminary results. Radiat Oncol 4:15
Bentzen SM, Harari PM, Tome WA et al (2008) Radiation oncology advances: an introduction. Cancer Treat Res 139:1–4
Brink I, Schumacher T, Mix M et al (2004) Impact of [18 F]FDG-PET on the primary staging of small-cell lung cancer. Eur J Nucl Med Mol Imaging 31:1614–1620
Caldwell CB, Mah K, Skinner M et al (2003) Can PET provide the 3D extent of tumor motion for individualized internal target volumes? A phantom study of the limitations of CT and the promise of PET. Int J Radiat Oncol Biol Phys 55:1381–1393
Chapet O, Kong FM, Quint LE et al (2005) CT-based definition of thoracic lymph node stations: an atlas from the University of Michigan. Int J Radiat Oncol Biol Phys 63:170–178
Collier DC, Burnett SS, Amin M et al (2003) Assessment of consistency in contouring of normal-tissue anatomic structures. J Appl Clin Med Phys 4:17–24
Darby SC, Ewertz M, McGale P et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998
de Langen AJ, Raijmakers P, Riphagen I et al (2006) The size of mediastinal lymph nodes and its relation with metastatic involvement: a meta-analysis. Eur J Cardiothorac Surg 29:26–29
De Leyn P, Stroobants S, De Wever W et al (2006) Prospective comparative study of integrated positron emission tomography-computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 Non-small-cell lung cancer: a Leuven Lung Cancer Group Study. J Clin Oncol 24:3333–3339
De Ruysscher D, Wanders S, van Haren E et al (2005) Selective mediastinal node irradiation based on FDG-PET scan data in patients with non-small-cell lung cancer: a prospective clinical study. Int J Radiat Oncol Biol Phys 62:988–994
De Ruysscher D, Bremer RH, Koppe F et al (2006) Omission of elective node irradiation on basis of CT-scans in patients with limited disease small cell lung cancer: a phase II trial. Radiother Oncol 80:307–312
De Ruysscher D, Dehing C, Bremer RH et al (2007) Maximal neutropenia during chemotherapy and radiotherapy is significantly associated with the development of acute radiation-induced dysphagia in lung cancer patients. Ann Oncol 18:909–916
De Ruysscher D, Wanders R, van Haren E et al (2008) HI-CHART: a phase I/II study on the feasibility of high-dose continuous hyperfractionated accelerated radiotherapy in patients with inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 71:132–138
De Ruysscher D, Faivre-Finn C, Nestle U et al (2010) European Organisation for Research and Treatment of Cancer recommendations for planning and delivery of high-dose, high-precision radiotherapy for lung cancer. J Clin Oncol 28:5301–5310
Dehing-Oberije C, De Ruysscher D, van Baardwijk A et al (2009) The importance of patient characteristics for the prediction of radiation-induced lung toxicity. Radiother Oncol 91:421–426
Delanian S, Lefaix JL, Pradat PF (2012) Radiation-induced neuropathy in cancer survivors. Radiother Oncol 105:273–282
Doll C (2014) When there is no expert – ask your colleague! influence of experience and qualification on PET-based target volume delineation. Strahlenther Onkol 190:555–562
Dunlap NE, Cai J, Biedermann GB et al (2010) Chest wall volume receiving >30 Gy predicts risk of severe pain and/or rib fracture after lung stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 76:796–801
Dwamena BA, Sonnad SS, Angobaldo JO et al (1999) Metastases from non-small cell lung cancer: mediastinal staging in the 1990s–meta-analytic comparison of PET and CT. Radiology 213:530–536
Emami B, Mirkovic N, Scott C et al (2003) The impact of regional nodal radiotherapy (dose/volume) on regional progression and survival in unresectable non-small cell lung cancer: an analysis of RTOG data. Lung Cancer 41:207–214
Eschmann SM, Friedel G, Paulsen F et al (2007) Impact of staging with 18 F-FDG-PET on outcome of patients with stage III non-small cell lung cancer: PET identifies potential survivors. Eur J Nucl Med Mol Imaging 34:54–59
Everitt S, Plumridge N, Herschtal A et al (2013) The impact of time between staging PET/CT and definitive chemo-radiation on target volumes and survival in patients with non-small cell lung cancer. Radiother Oncol 106:288–291
Feng M, Moran JM, Koelling T et al (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79:10–18
Fischer BM, Mortensen J, Langer SW et al (2007) A prospective study of PET/CT in initial staging of small-cell lung cancer: comparison with CT, bone scintigraphy and bone marrow analysis. Ann Oncol 18:338–345
Forquer JA, Fakiris AJ, Timmerman RD et al (2009) Brachial plexopathy from stereotactic body radiotherapy in early-stage NSCLC: dose-limiting toxicity in apical tumor sites. Radiother Oncol 93:408–413
Gagliardi G, Constine LS, Moiseenko V et al (2010) Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 76:S77–S85
Gambhir SS, Czernin J, Schwimmer J et al (2001) A tabulated summary of the FDG PET literature. J Nucl Med 42:1S–93S
Giraud P, Antoine M, Larrouy A et al (2000) Evaluation of microscopic tumor extension in non-small-cell lung cancer for three-dimensional conformal radiotherapy planning. Int J Radiat Oncol Biol Phys 48:1015–1024
Giraud P, De Rycke Y, Lavole A et al (2006) Probability of mediastinal involvement in non-small-cell lung cancer: a statistical definition of the clinical target volume for 3-dimensional conformal radiotherapy? Int J Radiat Oncol Biol Phys 64:127–135
Goeckenjan G, Sitter H, Thomas M et al (2010) Prevention, diagnosis, therapy, and follow-up of lung cancer. Pneumologie 64(Suppl 2):e1–e164
Goldstraw P, Crowley J, Chansky K et al (2007) The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2:706–714
Grutters JP, Kessels AG, Pijls-Johannesma M et al (2010) Comparison of the effectiveness of radiotherapy with photons, protons and carbon-ions for non-small cell lung cancer: a meta-analysis. Radiother Oncol 95:32–40
Guckenberger M, Allgauer M, Appold S et al (2013) Safety and efficacy of stereotactic body radiotherapy for stage i non-small-cell lung cancer in routine clinical practice: a patterns-of-care and outcome analysis. J Thorac Oncol 8:1050–1058
Harris KM, Adams H, Lloyd DC et al (1993) The effect on apparent size of simulated pulmonary nodules of using three standard CT window settings. Clin Radiol 47:241–244
Hayman JA, Martel MK, Ten Haken RK et al (2001) Dose escalation in non-small-cell lung cancer using three-dimensional conformal radiation therapy: update of a phase I trial. J Clin Oncol 19:127–136
Hellwig D, Baum RP, Kirsch C (2009) FDG-PET, PET/CT and conventional nuclear medicine procedures in the evaluation of lung cancer: a systematic review. Nuklearmedizin 48:59–69, quiz N8-9
Hoekstra CJ, Stroobants SG, Smit EF et al (2005) Prognostic relevance of response evaluation using [18 F]-2-fluoro-2-deoxy-D-glucose positron emission tomography in patients with locally advanced non-small-cell lung cancer. J Clin Oncol 23:8362–8370
Huang K, Dahele M, Senan S et al (2012) Radiographic changes after lung stereotactic ablative radiotherapy (SABR)–can we distinguish recurrence from fibrosis? A systematic review of the literature. Radiother Oncol 102:335–342
Hurkmans CW, Cuijpers JP, Lagerwaard FJ et al (2009) Recommendations for implementing stereotactic radiotherapy in peripheral stage IA non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase III ROSEL study. Radiat Oncol 4:1
ICRU (1999) Prescribing, recording and reporting photon beam therapy. Supplement to report 50, in ICRU (ed), International Commission on Radiation Units and Measurements. Bethesda, USA
Jeremic B (2004) Incidental irradiation of nodal regions at risk during limited-field radiotherapy (RT) in dose-escalation studies in nonsmall cell lung cancer (NSCLC). Enough to convert no-elective into elective nodal irradiation (ENI)? Radiother Oncol 71:123–125
Jo IY, Kay CS, Kim JY et al (2014) Significance of low-dose radiation distribution in development of radiation pneumonitis after helical-tomotherapy-based hypofractionated radiotherapy for pulmonary metastases. J Radiat Res 55:105–112
Kara M, Sak SD, Orhan D et al (2000) Changing patterns of lung cancer; (3/4 in.) 1.9 cm; still a safe length for bronchial resection margin? Lung Cancer 30:161–168
Kirkpatrick JP, van der Kogel AJ, Schultheiss TE (2010) Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 76:S42–S49
Komaki R, Putnam JB Jr, Walsh G et al (2000) The management of superior sulcus tumors. Semin Surg Oncol 18:152–164
Kong FM, Ritter T, Quint DJ et al (2011) Consideration of dose limits for organs at risk of thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. Int J Radiat Oncol Biol Phys 81:1442–1457
Kristensen CA, Nottrup TJ, Berthelsen AK et al (2009) Pulmonary toxicity following IMRT after extrapleural pneumonectomy for malignant pleural mesothelioma. Radiother Oncol 92:96–99
Lagerwaard FJ, Haasbeek CJ, Smit EF et al (2008) Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 70:685–692
Le Pechoux C (2011) Role of postoperative radiotherapy in resected non-small cell lung cancer: a reassessment based on new data. Oncologist 16:672–681
Liao ZX, Komaki RR, Thames HD Jr et al (2010) Influence of technologic advances on outcomes in patients with unresectable, locally advanced non-small-cell lung cancer receiving concomitant chemoradiotherapy. Int J Radiat Oncol Biol Phys 76:775–781
LoCicero J, Ponn RB, Rusch VW (2005) General thoracic surgery, 6th edn. Lippincott Williams & Wilkins, Philadelphia
MacDonald SL, Hansell DM (2003) Staging of non-small cell lung cancer: imaging of intrathoracic disease. Eur J Radiol 45:18–30
MacManus MP, Hicks RJ, Ball DL et al (2001) Imaging with F-18 FDG PET is superior to Tl-201 SPECT in the staging of non-small cell lung cancer for radical radiation therapy. Australas Radiol 45:483–490
Marks LB, Bentzen SM, Deasy JO et al (2010) Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys 76:S70–S76
Miller KL, Shafman TD, Anscher MS et al (2005) Bronchial stenosis: an underreported complication of high-dose external beam radiotherapy for lung cancer? Int J Radiat Oncol Biol Phys 61:64–69
Mountain CF, Dresler CM (1997) Regional lymph node classification for lung cancer staging. Chest 111:1718–1723
Nestle U, Kremp S, Grosu A (2006) Practical integration of [(18)F]-FDG-PET and PET-CT in the planning of radiotherapy for non-small cell lung cancer (NSCLC): the technical basis, ICRU-target volumes, problems, perspectives. Radiother Oncol 81:209–225
Nestle U, Faivre-Finn C, Deruysscher D et al (2013) Stereotactic body radiotherapy (SBRT) in central non-small cell lung cancer (NSCLC): solid evidence or “no-go”? Radiother Oncol 109:178–179
Nieder C, Grosu AL, Andratschke NH et al (2006) Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys 66:1446–1449
Onimaru R, Shirato H, Shimizu S et al (2003) Tolerance of organs at risk in small-volume, hypofractionated, image-guided radiotherapy for primary and metastatic lung cancers. Int J Radiat Oncol Biol Phys 56:126–135
Pandit N, Gonen M, Krug L et al (2003) Prognostic value of [18F]FDG-PET imaging in small cell lung cancer. Eur J Nucl Med Mol Imaging 30:78–84
Pettersson N, Nyman J, Johansson KA (2009) Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy of non-small cell lung cancer: a dose- and volume-response analysis. Radiother Oncol 91:360–368
Pijls-Johannesma M, De Ruysscher D, Vansteenkiste J et al (2007) Timing of chest radiotherapy in patients with limited stage small cell lung cancer: a systematic review and meta-analysis of randomised controlled trials. Cancer Treat Rev 33:461–473
Puderbach M, Hintze C, Ley S et al (2007) MR imaging of the chest: a practical approach at 1.5T. Eur J Radiol 64:345–355
Robinson LA, Ruckdeschel JC, Wagner H Jr et al (2007) Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:243S–265S
Rosenzweig KE, Fox JL, Yorke E et al (2005) Results of a phase I dose-escalation study using three-dimensional conformal radiotherapy in the treatment of inoperable nonsmall cell lung carcinoma. Cancer 103:2118–2127
Rosenzweig KE, Sura S, Jackson A et al (2007) Involved-field radiation therapy for inoperable non small-cell lung cancer. J Clin Oncol 25:5557–5561
Salguero FJ, Belderbos JS, Rossi MM et al (2013) Microscopic disease extensions as a risk factor for loco-regional recurrence of NSCLC after SBRT. Radiother Oncol 109:26–31
Senthi S, Haasbeek CJ, Slotman BJ et al (2013) Outcomes of stereotactic ablative radiotherapy for central lung tumours: a systematic review. Radiother Oncol 106:276–282
Slotman BJ, Lagerwaard FJ, Senan S (2006) 4D imaging for target definition in stereotactic radiotherapy for lung cancer. Acta Oncol 45:966–972
Spoelstra FO, Senan S, Le Pechoux C et al (2010) Variations in target volume definition for postoperative radiotherapy in stage III non-small-cell lung cancer: analysis of an international contouring study. Int J Radiat Oncol Biol Phys 76:1106–1113
Sura S, Greco C, Gelblum D et al (2008) (18)F-fluorodeoxyglucose positron emission tomography-based assessment of local failure patterns in non-small-cell lung cancer treated with definitive radiotherapy. Int J Radiat Oncol Biol Phys 70:1397–1402
Taremi M, Hope A, Lindsay P et al (2012) Predictors of radiotherapy induced bone injury (RIBI) after stereotactic lung radiotherapy. Radiat Oncol 7:159
Thorwarth D, Beyer T, Boellaard R et al (2012) Integration of FDG-PET/CT into external beam radiation therapy planning: technical aspects and recommendations on methodological approaches. Nuklearmedizin 51:140–153
Timmerman R, McGarry R, Yiannoutsos C et al (2006) Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 24:4833–4839
Tofts R, Lee P, Sung A (2013) Interventional pulmonology approaches in the diagnosis and treatment of early stage non small cell lung cancer. Transl Lung Cancer Res 2:316–331
Underberg RW, Lagerwaard FJ, Slotman BJ et al (2005) Benefit of respiration-gated stereotactic radiotherapy for stage I lung cancer: an analysis of 4DCT datasets. Int J Radiat Oncol Biol Phys 62:554–560
van Loon J, Offermann C, Bosmans G et al (2008) 18FDG-PET based radiation planning of mediastinal lymph nodes in limited disease small cell lung cancer changes radiotherapy fields: a planning study. Radiother Oncol 87:49–54
Van Sornsen de Koste JR, de Boer HC, Schuchhard-Schipper RH et al (2003) Procedures for high precision setup verification and correction of lung cancer patients using CT-simulation and digitally reconstructed radiographs (DRR). Int J Radiat Oncol Biol Phys 55:804–810
van Tinteren H, Hoekstra OS, Smit EF et al (2002) Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet 359:1388–1393
Videtic GM, Belderbos JS, Spring Kong FM et al (2008) Report from the International Atomic Energy Agency (IAEA) consultants’ meeting on elective nodal irradiation in lung cancer: small-cell lung cancer (SCLC). Int J Radiat Oncol Biol Phys 72:327–334
Wahidi MM, Govert JA, Goudar RK et al (2007) Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:94S–107S
Werner-Wasik M, Yorke E, Deasy J et al (2010) Radiation dose-volume effects in the esophagus. Int J Radiat Oncol Biol Phys 76:S86–S93
Wolthaus JW, Sonke JJ, van Herk M et al (2008) Comparison of different strategies to use four-dimensional computed tomography in treatment planning for lung cancer patients. Int J Radiat Oncol Biol Phys 70:1229–1238
Yuan S, Meng X, Yu J et al (2007) Determining optimal clinical target volume margins on the basis of microscopic extracapsular extension of metastatic nodes in patients with non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 67:727–734
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Nestle, U., Adebahr, S., Schimek-Jasch, T. (2015). Lung Cancer. In: Grosu, AL., Nieder, C. (eds) Target Volume Definition in Radiation Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45934-8_5
Download citation
DOI: https://doi.org/10.1007/978-3-662-45934-8_5
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-45933-1
Online ISBN: 978-3-662-45934-8
eBook Packages: MedicineMedicine (R0)