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Patient Selection:
-
HEART:
mediastinal disease extending below the origin of coronaries.
-
BREAST:
young females where proton therapy can reduce breast dose and subsequent risk of secondary
breast cancer.
-
Heavily pretreated patients
who are at higher risk of radiation related toxicities to the heart or lung
When using proton therapy,
the treating physician
should:
-Demonstrate a
benefit
for the patient, due to the increased costs and difficulty in delivering the treatment
compared with photons.
-Understand that lymphoma proton planning is complex, due to the management of
uncertainties
, and
evolving with utilization of PBS, in-room volumetric imaging, and robustness optimization
-Utilize
deep inspiration breath hold
when warranted to further minimize dose to the OARs, understanding
the increased complexity of using DIBH with proton therapy compared with photon therapy