How do you approach adaptive planning in lung cancer?
Are there any rules you follow? Do you shrink target volumes if you notice a significant response (via CBCT) in a bulky lung tumor with fractionated radiation? Does NSCLC vs. SCLC make a difference in your decision making? There are some tumors that seem to regress with pushing borders in the lung, but there is concern that tumors don't just "pull away" as they're responding in real time, but rather "disintegrate". What are your criteria for rescanning?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · University of Wisconsin Hospital & Clinics
Answered on
The role of adaptive radiotherapy in lung cancer is still under investigation.
I do daily CBCTs on my definitive NSCLC and small cell lung cancer patients. I only adapt plans if there is a change in anatomy such as opening of a collapsed lung or tumor growth outside of the PTV.
I do not shrink volum...
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Mednet MemberInvited Expert
Radiation Oncology · Thomas Jefferson University Hospital
Answered on
I only use adaptive thoracic RT for non-small cell lung cancer when faced with a large tumor associated with a (subjectively judged) high lung V20 (for example, >30-35%). Tumors treated with concurrent chemo-radiotherapy have a reasonable chance of shrinking (15-20%), so I replan around 36-40 Gy. I ...
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