الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In the last century carcinoma of the lung has progressed from an uncommon and obscure disease to the most common cancer in the world and the most common cause of death from cancer.
NSCLC accounts for 80% of all lung cancer cases. Approximately 40% of NSCLC patients present with inoperable stages IIIA and IIIB disease, Patients were considered inoperable on the basis of mediastinal lymph node involvement (N2 or N3), bulky primary disease (T3 or T4), and/or advanced disease states. TRT concurrent with cytotoxic chemotherapy or sequential chemo-radiation has been the traditional treatment approach for patients with inoperable stages IA and IIIB NSCLC.
SCLC accounts for approximately 15% of the lung cancer cases. Nearly one third of these are categorized as LS. LS-SCLC remains a therapeutic challenge to medical and radiation oncologists. The treatment of which has evolved significantly over the last two decades with combined-modality therapy now the standard of care. The addition TRT to standard chemotherapy has led to improvements in long-term survival in this population.
In this study we aimed to compare 3D CRT to IMRT in locally advanced lung cancer as regards normal tissue irradiation and target coverage using COSI & mCOSI indices, DVH, HI, CI, Dmax & Dmean.
Additionally to evaluate late toxicity of esophagus, heart and lung in patients with locally advanced lung cancer who received 3D CRT, definitive concurrent chemo-radiation or sequential chemo-radiation according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
This study was approved by the institutional review board at Ain Shams University. 20 patients were selected to participate in our study from 2014 till 2019. They were recruited from bronchogenic cancer clinic, clinical oncology department in Ain Shams University Hospitals using a convenient sampling method. Diagnosis of NSCLC or SCLC was confirmed histologically and further radiological assessment for TNM staging was performed. All patients where 18 years old or older and were prescribed for either combined or sequential chemoradiotherapy for treatment of locally invasive lung cancer with ECOG PS equal or less than 2.
However, patients who did not receive full dose as planned, lost to follow up, had their treatment interrupted for a period of at least 2 weeks intermittently or continuously, received palliative radiotherapy with dose less than the definitive dose (60-66 Gy) or discovered to be metastatic after starting their radiotherapy were excluded from the study.
As regards the conformity indices measured and compared between IMRT and 3D CRT, our study showed significantly more dose conformity using IMRT compared to 3D CRT. And while mean values of HI were also superior in IMRT compared to 3D CRT, no statistically significance could be obtained in our analysis between both measurements. It is possible that larger population could have helped achieving statistically significant end points as regards HI.
Not many studies in the literature compared between IMRT and 3D CRT as regards TCI. And although values were superior in favor of IMRT compared to 3D CRT, no statistical significance could be achieved. This can be overcome in further studies by using larger population sample.
To the best of current knowledge, no studies are available in the literature comparing between IMRT and 3D CRT in lung cancer as regards COSI and mCOSI. However, our study found superior mean values for both indices in favor of IMRT compared to 3D CRT. Statistical significance could only be obtained for mCOSI.