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For ultracentral lung cancer abutting the heart, what dose constraints would you use for the heart and bronchus if using 10 fraction ultrahypofractionation?

NCCN guidelines allow the heart to get 105% of PTV prescription for 5 fractions to 55 Gy, but Timmerman tables from 2021 state the heart should be below 42.5 Gy for 10 fraction treatment.
2 Answers
Mednet Member
Mednet Member
Radiation Oncology · Tennessee Oncology
Answered on

The dose deviation from Timmerman for the heart is 60 Gy in 10 fractions. Now that they are published, I'd utilize the SUNSET constraints. Patients received 60 Gy/8 fractions (rather than the 10 fraction regimens questioned here) but the best data we have to extrapolate and use constraints that are ...

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Mednet Member
Mednet MemberInvited Expert
Radiation Oncology · University of Texas MD Anderson Cancer Center
Answered on

For "intra-central lung cancer” that closes or abuts the heart or bronchial tree, we could potentially treat with 70 Gy in 10 fractions with SIB GTV to 80 Gy. We typically keep heart Dmax<60 Gy, V50 Gy < 1cc; bronchial tree Dmax <60 Gy, and V50 < 1 cc. We understand this is a conservative dose-volum...

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