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Volume definition in radiotherapy planning for lung cancer: how the radiologist can help
Abstract
Effective treatment for carcinoma of the lung remains one of the
biggest challenges in oncology. Radical radiotherapy may be a
curative option for patients who are unsuitable for radical
surgery either because of disease stage or because of
co-morbidity. Long-term disease control with radical
radiotherapy is disappointing with only about 6% of patients
treated being alive at 5 years [1]. Technological advances
involved in the planning and delivery of radiotherapy may
improve this. The advent of conformal radiotherapy, utilizing
computed tomography and three-dimensional planning systems,
allows much more accurate shaping of the radiation fields. This
greater accuracy of target volume definition facilitates a
reduction in the radiation dose to normal tissues, allowing for
dose escalation to the tumour. Delineation of the target volume
can be problematic. Conventional CT has limitations in term of
distinguishing between benign and malignant tissues, e.g. the
size criteria for involved lymph nodes. The oncologist uses a
combination of radiological and clinical information when
defining the target volume but their radiological interpretation
of imaging is inferior to that of a radiologist.
The Royal College of Radiologists (RCR) issued guidance in 2004
on the optimal imaging strategies for common cancers. These
guidelines address issues regarding the localisation and staging
of cancers and treatment planning, and also reporting and
training. They recommend the development of closer links between
radiologists and oncologists to optimise the interpretation of
imaging and target volume definition.
This article aims to briefly explain the planning process
involved in irradiating lung cancers, highlight problematic
areas and suggest ways in which co-operation with radiologists
may improve the delivery of radiotherapy and therefore the
treatment outcomes for this group of patients.
Author
A E F Roy and P Wells
Contact Details
Corresponding address:
Amy Roy,
Department of Clinical Oncology,
St Bartholomew's Hospital,
London EC1 7BE, UK
Reference
ICIS Cancer Imaging Volume 6 Issue 1
DOI: 10.1102/1470-7330.2006.0019
Date Posted
7 September 2006
Open Access is provided for this article.
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