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Practical considerations for lung planning…
•
4D simulation with PET/CT fusion:
Limit patient
acceptance to < 1 cm respiratory tumor excursion
•
ITV
•
Expand ITV + 7mm= CTV
•
CTV + 5mm= PTV
•
Typically use 3 beams (can treat 2 fields/day)
•
Limit 1/3 of the beams to range into critical structure
(cord/esophagus/ heart etc)
<1cm
Inclusion criteria has been largely
accepted by proton centers using
pencil beam scanning exclusively
Majority of centers in the US treat
without or minimal motion
management
Issue of QACT for Re-Planning
without clear guidelines:
Dependent on institution and
imaging capabilities and
practicality