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

Radiotherapy and Oncology. 2008 Jan 17 [Epub ahead of print] [Link]

Sterzing F, Sroka-Perez G, Schubert K, Münter MW, Thieke C, Huber P, Debus J, Herfarth KK.

Department of Radiation Oncology, University of Heidelberg, Germany.


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 HImax and HImin 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