Purpose: Patients with non-small cell lung cancer (NSCLC) and malignant pleural effusion (MPE) are difficult to manage clinically. In this study, we designed a protocol of combined ipsilateral pleura radiotherapy with intrapleural(i.p.) and intravenous(i.v.) chemotherapy to enhance local as well as systemic control of the disease.Method: From January 2006 to January 2011, 31 patients with NSCLC and MPE were eligible for the study. After adequate drainage, patients received chemotherapy (cisplatin 60mg/m 2 i.p. on day 1, paclitaxel 125mg/m 2 and cisplatin 75mg/m 2 on days 3 and 31 i.v.), and after first cycle chemotherapy followed by forward IMRT. Radiation targets included primary tumor, mediastinal, lymphatic drainage area, the ipsilateral pleura and 1/2 pleural effusion. The radiation dose is 190cGy / fraction. After 6080cGy/32 fractions delivered, residues tumours were given with boost irradiation 570～950 cGy /3～5 fractions.Result: Overall response of pleural effusion was 90.3% with 38.7% complete remission, 51.6% with partial remission, 6.5% stable disease, and 3.2 % progressive disease. The median failure-free and overall survival was 13 and18 months, respectively. 1-and 2-years overall survival was 77.3% and 19.9%. Grade 1, 2, 3 and 4 of lung and esophagus acute radiation-induced toxicity was 58.1%,19.4%,3.2% and 0% and 48.4%9.7%, 3.2% and 0%. The rate of grade 1, 2, 3 and 4 with hematologic toxicity was 38.5%, 23.1%, 3.8%, and 0%. Conclusion:Ipsilateral pleura radiotherapy combined with intrapleural and intravenous Chemotherapy for patients with NSCLC presenting malignant pleural effusion is feasible, effective, and provides an alternative treatment modality for them.

Purpose: Tomotherapy consists of helical radiotherapy using a computed tomography (CT)-like gantry and a rotating radiation beam that passes through the target area of interest; this modality has been used in the management of primary central nervous system tumors and viscerabased malignancies. It provides unprecedented accuracy in beam delivery allowing for an increase in tumour dose, thereby increasing the likelihood of cancer cure while at the same time reducing treatment complications in healthy tissues. The main purpose of Study is to Investigate Tumor motion limitation for effective radiotherapy of Lung Cancer specifically for Helical Tomotherapy in Harbin Medical University Affiliated Cancer Hospital. Simultaneous and continuous movements of tomotherapy subsystems (gantry, couch, and binary multi-leaf collimator) can lead to inaccurate dose delivery, when combined with tumor motion. Methods:In this present study, we have investigated the influence of tumour motion and strategies to reduce the resulting dose differences for helical tomotherapy, through computer simulations and film measurements performed in a dynamic body phantom. Three distinctively different types of dose discrepancies have been isolated: dose rounding, dose rippling, and the intensity-modulated radiation therapy (IMRT) asynchronization effect. Each effect was shown to be affected by different combinations of tumour motion and treatment parameters. In clinical practice using a conventional fractionation scheme, the dose rounding effect remains the major concern, which can be compensated by assigning a larger treatment margin around the tumour volume. For hypofractionation schemes, the IMRT asynchronization effect can become an additional concern by introducing dose discrepancies inside the target volume, necessitating the use of a motion management technique.Results: Three different types of dissimilarities arising from the presence longitudinal tumour motion during helical tomotherapy were identified. Their characteristics were investigated through both computer simulation modeling and experimental verification using a motion phantom with film. The characteristics of the three different motion-induced dose discrepancies were illustrated, and the dosimetric significance of each effect was described. Conclusion:Investigated measured data within +0.5 % and +1.5 % inside the PTV region for the non-IMRT and IMRT tomotherapy deliveries, respectively. Various potential solutions to minimize the effect of target motion were also discussed, and each proposed method needs to be investigated for its effectiveness in suppressing the three dose discrepancies described here. The computer simulation model could also prove useful during the patient selection process for the different approaches of minimizing dose artifacts