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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