Evaluating target coverage and normal tissue sparing in the adjuvant radiotherapy of malignant pleural mesothelioma: Helical tomotherapy compared with step-and-shoot IMRT

Sterzing, Florian; Sroka-Perez, Gabriele; Schubert, Kai; Münter, Marc W.; Thieke, Christian; Huber, Peter; Debus, Jürgen; Herfarth, Klaus K.

doi:10.1016/j.radonc.2007.12.010

« Previous Next »Radiotherapy & Oncology
Volume 86, Issue 2 , Pages 251-257, February 2008

Evaluating target coverage and normal tissue sparing in the adjuvant radiotherapy of malignant pleural mesothelioma: Helical tomotherapy compared with step-and-shoot IMRT

Florian Sterzing
- Department of Radiation Oncology, University of Heidelberg, Germany
- Corresponding author. Florian Sterzing, Department of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany.
Gabriele Sroka-Perez
- Department of Radiation Oncology, University of Heidelberg, Germany
Kai Schubert
- Department of Radiation Oncology, University of Heidelberg, Germany
Marc W. Münter
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (dkfz), Heidelberg, Germany
Christian Thieke
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (dkfz), Heidelberg, Germany
Peter Huber
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (dkfz), Heidelberg, Germany
Jürgen Debus
- Department of Radiation Oncology, University of Heidelberg, Germany
Klaus K. Herfarth
- Department of Radiation Oncology, University of Heidelberg, Germany

Received 25 February 2007; received in revised form 8 December 2007; accepted 11 December 2007. published online 21 January 2008.

Abstract

Purpose

To evaluate the potential of helical tomotherapy in the adjuvant treatment of malignant pleural mesothelioma and compare target homogeneity, conformity and normal tissue dose with step-and-shoot intensity-modulated radiotherapy.

Methods and materials

Ten patients with malignant pleural mesothelioma who had undergone neoadjuvant chemotherapy with cisplatin and permetrexed followed by extrapleural pneumonectomy (EPP) were treated in our department with 54Gy to the hemithorax delivered by step-and-shoot IMRT. A planning comparison was performed by creating radiation plans for helical tomotherapy. The different plans were compared by analysing target homogeneity using the homogeneity indices HI_max and HI_min and target conformity by using the conformity index CI₉₅. To assess target coverage and normal tissue sparing TV₉₀, TV₉₅ and mean and maximum doses were compared.

Results

Both modalities achieved excellent dose distributions while sparing organs at risk. Target coverage and homogeneity could be increased significantly with helical tomotherapy compared with step-and-shoot IMRT. Mean dose to the contralateral lung could be lowered beyond 5Gy.

Conclusions

Our planning study showed that helical tomotherapy is an excellent option for the adjuvant intensity-modulated radiotherapy of MPM. It is capable of improving target coverage and homogeneity.

Keywords: MPM, Mesothelioma, Step-and-shoot IMRT, Helical tomotherapy