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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 2010 estimates by the American Cancer Society, lung cancer has both the highest incidence and mortality of all malignancies in the United States. Overall, outcomes, though improving, remain poor, and radiation therapy (RT) is an important mainstay of locoregional therapy. The technical challenges of delivering biologically effective doses of RT capable of achieving adequate local control are many and relate to target definition, respiratory tumor motion, tissue heterogeneities and normal tissue tolerance. Advancements over standard two-dimensional RT, including three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and more recently volumetrically-modulated arc therapy (VMAT), in addition to four-dimensional (4D) CT simulation and planning techniques, using biological targeting via positron emission tomography (PET) and 2 and 3-D image-guided delivery methods have aided the path toward achieving radiation dose escalation while concurrently sparing organs at risk (OAR) and reducing target miss. IMRT planning studies have shown improvements over 3D-CRT with respect to tumor dose escalation and OAR dose, particularly for locally-advanced disease. This, however, is potentially at the cost of longer treatment times, monitor units, and volume of lung receiving low dose, with some concern for higher pneumonitis rates. Commercial planning software and quality assurance measures now allow for dynamically delivered VMAT, which similarly may achieve higher tumor dose and lower OAR dose while concurrently reducing treatment times and monitor units and increasing target conformality. Though IMRT and VMAT planning studies and short-term, single-institution clinical data are encouraging, long-term, multi-institutional studies comparing these techniques to 2D or 3D-CRT in terms of locoregional control, survival, and quality of life are lacking but should be supported.

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Notes

  1. 1.

    For the purposes of this chapter, the abbreviation “IMRT” by default will 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, VMAT, etc. 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). Here forward, 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 its own modality (not to be incorporated by default with the terms “IMRT,” “arc therapy,” “IMAT,” or “VMAT.”

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Authors and Affiliations

  1. Department of Radiation Oncology, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI, 48073-6769, USA

    Inga S. Grills & Victor S. Mangona

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  1. Inga S. Grills
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  2. Victor S. Mangona
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Correspondence to Inga S. Grills .

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  1. Institute of Lung Diseases, Institutski put 4, Sremska Kamenica, 21204, Serbia

    Branislav Jeremic

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© 2011 Springer-Verlag Berlin Heidelberg

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Grills, I.S., Mangona, V.S. (2011). Intensity-Modulated Radiation Therapy and Volumetric-Modulated Arc Therapy for Lung Cancer. In: Jeremic, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_283

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  • DOI: https://doi.org/10.1007/174_2011_283

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