Course book Advanced Treatment Planning 2018

Further considerations:

if constraints cannot be reached, a compromise may be needed.

Possible trade-offs for compromise:

- discuss to loosen PTV coverage from lower constraint 99% receiving 95% of the prescribed dose to 95%

- as pneumonitis may kill the patient soon, try to keep the lung constraints without compromise

- allow up to 50 Gy point dose to the spinal cord and/or steep dose gradients near to the spine, if IGRT is available

- allow more dose to the esophagus , as this will affect acute toxicity, which can be monitored and treated clinically

01.10.2018