Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

Abstract

Chemoradiotherapy is the current standard of care in patients withadvanced inoperable stage IIIA or IIIB non-small cell lung cancer(NSCLC). Three-dimensional radiotherapy (3DCRT) has been atrusted method for a long time and has well-known drawbacks, mostof which could be improved by Intensity Modulated Radiotherapy(IMRT). IMRT is not currently the standard treatment of locally advancedNSCLC, but almost all patients could benefit to a degree inorgan at risk sparing, dose coverage conformality, or dose escalation.The most critical step for a radiation oncology department isto strictly evaluate its own technical and physical capabilities todetermine the ability of IMRT to deliver an optimal treatment plan.This includes calculating the internal tumor motion (ideally 4DCT orequivalent techniques), treatment planning software with an up-todateheterogeneity correction algorithm, and daily image guidance. Itis crucial to optimise and individualise the therapeutic ratio for eachpatient during the decision of 3DCRT versus IMRT. The current literaturerationalises the increasing use of IMRT, including 4D imagingplus PET/CT, and encourages the applicable knowledge-based andindividualised dose escalation using advanced daily image-guidedradiotherapy.