The Influence of Lobe-based Radiotherapy Plan Optimization Method on Different Lymph Node Irradiation Schemes for Operable LA-NSCLC Patients

Purpose Various target volume delineation schemes differ greatly for stage IIIa NSCLC radiotherapy. Although tightened target volume may give patients the opportunity to receive radiotherapy, it is not absolutely safe to narrow the irradiation area. For IIIa NSCLC patients who will undergo lobectomy, a new neoadjuvant radiotherapy based on sparing preserved lung lobes may improve the dose distribution of the preserved lobe, and provide freedom for physicians in optimizing treatment strategies. Materials and methods Computed tomography imaging data of 20 IIIA- p N2 NSCLC patients were used to produce conventional IMRT(IMRT) and Preserved Lobe based IMRT(P-IMRT) plan respectively according to two different target volume delineation schemes(OPT1 and OPT2). Dose results of target coverage, Total lung, Ipsilateral lung, Preserved Total Lung, Preserved Ipsilateral Lung, Contralateral Lung, Resected Lobe and other OARs in the four groups were analyzed. Results All plans met dose limits. Lobe-based IMRT significantly reduce the irradiated dose of Lung lobes, especially Preserved Total Lung and Preserved Ipsilateral Lung, for both delineation schemes. Mean Dose of Preserved Total Lung decreased from 819.93 cGy to 690.98 cGy (OPT1) and 542.47 cGy to 469.62 cGy (OPT2), Mean Dose of Preserved Ipsilateral Lung decreased from 1282.95 cGy to 1068.55 cGy (OPT1) and 955.83 cGy to 795.97 cGy (OPT2), respectively. While the dose indices of Resected Lobe increased slightly for only about 1%. Comparing the four groups of plans, it’s more effective in optimizing the dose of lung lobes by this method for the delineation scheme with a large target volume. The lung dose metrics in P-IMRTOPT1 can be reduced to a value very close to that in IMRTOPT2, and some values are even lower than that in IMRTOPT2. Conclusion For IIIA-N2 NSCLC patients who will undergo lobectomy, no matter which target delineation scheme is chosen, preoperative neoadjuvant radiotherapy using a lobe -based planning can significantly reduce the radiation dose that preserves the lobes. Especially for the large-scale lymph node irradiation scheme, this method can also reduce the dose of preserved lung lobe to a level that is comparable to or lower than that of the conventional IMRT small-area lymph node irradiation scheme, and reduce the obstacles for clinicians in selecting the optimal individualized scheme.