What dose constraints do you use for a young female patient with an anterior mediastinal mass being treated definitively with IMRT?

I would emphasize regardless of modality the importance of positioning and its impact on breast dose. The vast majority of anterior mediastinal masses are supracardiac and extend superior to the level of the breasts when the patient is upright. If the patient is simulated supine with the arms up, th...

Based on published data we try to use:

• mean breast dose <4 Gy,
• mean heart <5 Gy and, mean lung < 10 Gy.

DIBH and MDA butterfly technique helps to achieve numbers closer to these numbers.

Dabaja et al., PMID 30108066

Baues et al., PMID 29970105

Dr. @Dr. First Last is correct if you are constrained to using photons, but as demonstrated by the citations, further significant dose reduction to the heart can be achieved with protons. Typically, we can reduce the mean heart dose by about 80% from the best achievable photon plan. Lung doses are u...