Chest tumors: current trends of clinical practice

This review summarizes recent updates on the role and timing of radiotherapy (RT). Multidisciplinary case discussion and careful case selection before any treatment modality can avoid morbidity and mortality. Advances in RT technology include proton treatment, respiratory gating, immobilization, forward planning, intensity-modulated radiation (IMRT), volumetric-modulated arc therapy (VMAT), tomotherapy, image-guided radiation treatment (IGRT) and on-treatment cone-beam computerized axial tomography scan (CBCT). These allow decreased doses to organ at risk such as brachial plexus, ribs, spinal cord, contralateral esophagus (CE), lung, heart, and adjacent liver. We used mesothelioma and thymoma as an example to illustrate improvements in RT techniques in past decade.