The Role of Three-Dimensional Conformal Radiotherapy in the Treatment of Mediastinal Tumors

  • Mack RoachIII
  • Srinivasan Vijayakumar
Part of the Medical Radiology book series (MEDRAD)

Abstract

Although considerable clinical experience has been accumulated in applying three-dimensional (3-D) technology to the treatment of prostatic carcinoma, the potential value of this technology in the management of thoracic neoplasms has only recently been recognized [1–10]. A variety of factors have contributed to this “lag” in the routine use of 3-D based technology for the management of thoracic neoplasms. First, the routine implementation of 3-D conformal radiotherapy (3-DCRT) has been hampered by the lack of widespread availability of FDA-approved 3-D software. The labor-intensive nature of 3-DCRT and the failure of many radiation oncologists to recognize the shortcomings of standard treatment techniques have also contributed to the slow diffusion of 3-D technology. Most investigators who have access to 3-D based treatment planning are convinced that the potential benefits associated with its routine use will ultimately result in its widespread adoption. To test the hypothesis that this technology will result in improved local control and possibly survival, phase I/II dose escalation studies sponsored by the Radiation Therapy Oncology Group (RTOG) are underway. In this review we discuss how this “tool” may allow us to improve the treatment of mediastinal tumors.

Keywords

Toxicity Lymphoma Oncol Sarcoma Hunt 

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References

  1. 1.
    Ten Haken RK, Perez-Tamayo C, Tesser RJ, McShan DL, Fraass BA, Lichter AS (1989) Boost treatment of the prostate using shaped, fixed fields. Int J Radiat Oncol Biol Phys 16: 193–200PubMedCrossRefGoogle Scholar
  2. 2.
    Roach M, Pickett B, Phillips TL (1993) An analysis of the advantages as well as the physical and clinical limitations of three-dimensionally (3-D) based coplanar conformal external beam irradiation (XRT) in the treatment of localized prostate cancer. In: Minet P (ed) Three-dimensional treatment planning. European Association of Radiology 5th Workshop on 3-D Treatment Planning, Liege, Belgium, pp 149–161Google Scholar
  3. 3.
    Soffen EM, Hanks GE, Hunt MA, Epstein BE (1992) Conformal static field radiation treatment of early prostate cancer versus non-conformal techniques: a reduction in acute morbidity. Int J Radiat Oncol Biol Phys 24: 485–488PubMedCrossRefGoogle Scholar
  4. 4.
    Vijayakumar S, Awan A, Karrison T, et al. (1993) Acute toxicity during external-beam radiotherapy for localized prostate cancer: comparison of different techniques. Int J Radiat Oncol Biol Phys 25: 359–371PubMedCrossRefGoogle Scholar
  5. 5.
    Sandler H, McLaughlin PW, Haken RT, Addison H, Forman J, Lichter A (1993) 3D conformal radiotherapy for the treatment of prostate cancer: low risk of chronic rectal morbidity observed in a large series of patients. Proceedings of the 35th ASTRO Meeting. Int J Radiat Oncol Biol Phys 27 (Suppl 1): 135Google Scholar
  6. 6.
    Emani B, Purdy JA, Manolis J., et al. (1991) three- dimensional treatment planning for lung cancer. Int J Radiat Oncol Biol Phys 21:217–227Google Scholar
  7. 7.
    Vijayakumar S, Myrianthopoulos LC, Rosenberg I, Halpern HJ, Low N, Chen GTY (1991) Optimization of radical radiotherapy with beam’s eye view techniques for non-small cell lung cancer. Int J Radiat Oncol Biol Phys 21:779–788PubMedCrossRefGoogle Scholar
  8. 8.
    Langer M, Kijewski P, Brown R, Ha C (1991) The effect on minimum tumor dose of restricting target-dose inhomogeneity in optimized three-dimensional treatment of lung cancer. Radiother Oncol 21: 245–256PubMedCrossRefGoogle Scholar
  9. 9.
    Hodapp N, Boesecke R, Schlegel W, Bruggmoster G, Wannemacher M (1991) Three-dimensional treatment planning for conformal therapy of a bronchial carcinoma. Radiother Oncol 20: 245–249PubMedCrossRefGoogle Scholar
  10. 10.
    Armstrong JG, Burman C, Leibel S, Fontenla D, Kutcher G, Zelefsky M, Fuks Z (1993) Three-dimensional conformal radiation therapy may improve the therapeutic ratio of high dose radiation therapy for lung cancer. Int J Radiat Oncol Biol Phys 26: 685–689PubMedCrossRefGoogle Scholar
  11. 11.
    Hazuka MB, Turrisi AT, Lutz ST, et al. (1993) Results of high-dose thoracic irradiation incorporating beam’s eye view display in non-small cell lung cancer: a retrospective multivariate analysis. Int J Radiat Oncol Biol Phys 27: 273–284PubMedGoogle Scholar
  12. 12.
    Perez CA, Stanley K, Grundy G, et al. (1982) Impact of irradiation technique and tumor extent in tumor control and survival of patients with unresectable non-oat cell carcinoma of the lung. Cancer 50: 1091–1099PubMedCrossRefGoogle Scholar
  13. 13.
    Vijayakumar S, Myrianthopoulos LC, Rosenberg I, Halpern HJ, Low N, Chen GTY (1991) Optimization of radical radiotherapy with beam’s eye view techniques for non-small cell lung cancer. Int J Radiat Oncol Biol Phys 21:779–788PubMedCrossRefGoogle Scholar
  14. 14.
    Vijayakumar S, Low N, Chen GTY, et al. (1991) Beam’s eye view-based photon radiotherapy, I. Int J Radiat Oncol Biol Phys 21: 1575–1586PubMedCrossRefGoogle Scholar
  15. 15.
    Purdy JA, Harms WB, Matthews JW, et al. (1993) Advances in 3-dimensional radiation treatment planning systems: room-view display with real time interactivity. Int J Radiat Oncol Biol Phys 27: 933–944PubMedCrossRefGoogle Scholar
  16. 16.
    Minet P, Constant ML, Biquet JF, Lemaire (1993) Probability of lymph node invasion in lung cancer: a tool to delineate the target volume. In: Minet P (ed) Three- dimensional treatment planning, European Association of Radiology, Liege, Belgium, pp 57–68Google Scholar
  17. 17.
    Kukolowicz P, Michalski W, Bulski W (1993) Threshold integral dose optimization criterion. In: Minet P(ed) Three-dimensional treatment planning, European Association of Radiology, Liege, Belgium, pp 199–206Google Scholar
  18. 18.
    Langer M, Brown R, Kijewski P, Ha C (1993) The reliability of optimization under dose-volume limits. Int J Radiat Oncol Biol Phys 26: 529–538PubMedCrossRefGoogle Scholar
  19. 19.
    Roach M, Pickett B, Kuerth S, Yuo H-S, Phillips TL (1994) The impact of tumor location on the benefits of 3-D based high-dose conformal thoracic irradiation. International Congress for Lung Cancer Meeting, June 22–26, 1994, Athens, GreeceGoogle Scholar
  20. 20.
    Valley J, Mirimanoff R (1993) Comparison of treatment techniques for lung cancer. Radiother Oncol 28: 168–173PubMedCrossRefGoogle Scholar
  21. 21.
    Emami B, Lyman J, et al. (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21: 109–122PubMedGoogle Scholar
  22. 22.
    Marks LB, Spencer DP, Bentel GC, et al. (1993) The utility of SPECT lung perfusion scans in minimizing and assessing the physiologic consequences of thoracic irradiation. Int J Radiat Oncol Biol Phys 26: 659–668PubMedCrossRefGoogle Scholar
  23. 23.
    Byhardt RW, Martin L, Pajak TF, Shin KH, Emami B, Cox JD (1993) The influence of field size and other treatment factors on pulmonary toxicity following hyperfractionated irradiation for inoperable non-small cell lung cancer (NSCLC)-analysis of a radiation therapy oncology group (RTOG) protocol. Int J Radiat Oncol Biol Phys 27:537–544PubMedCrossRefGoogle Scholar
  24. 24.
    Arriagada R, Lhevalier T, Quoix E, et al. (1991) Effect of chemotherapy on locally advanced non-small cell lung carcinoma: a randomized study of 353 patients. Int J Radiat Oncol Biol Phys 20: 1183–1190PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • Mack RoachIII
    • 1
  • Srinivasan Vijayakumar
    • 2
  1. 1.Department of Radiation Oncology, School of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Radiation and Cellular OncologyUniversity of Chicago/Pritzker School of MedicineChicagoUSA

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