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Summary
Patients diagnosed with advanced stage non-small cell lung cancer (NSCLC) face a cumbersome prognosis. Aggressive treatment is warranted, however, treatment induced toxicity often hampers further treatment intensification. Modern imaging techniques such as positron emission tomography (PET) may help in the improvement of treatment outcome as the biology of the tumor and its microenvironment can be visualized. In case tumor (sub)volumes harbour characteristics that are associated with increased treatment
resistance (e.g., hypoxia and/or increased metabolism), modern highly conformal radio-
therapy techniques like intensity-modulated radiation therapy (IMRT) and volumetric- modulated arc therapy (VMAT) enables radiotherapy dose escalation directed to these specific parts of the tumor with only a limited increase in toxicity. These modern radiotherapy techniques have different dose distribution characteristics compared to the
older radiotherapy techniques (i.e., 3-dimensional conformal radiotherapy, 3D-CRT).
Therefore, the available 3D-CRT based normal-tissue complication probability (NTCP) models need revision before these NTCP models may be useful in toxicity prediction in patients treated with either IMRT or VMAT. In this thesis the results of studies evaluating toxicity (prediction) for advanced staged NSCLC patients and the use of PET for radio- therapy planning are described.