How do you approach adaptive planning in lung cancer?

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...

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 ...