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Lung Cancer ASTRO refresher 2022,
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Turrisi didnt believe in a dose response curve beyond 45
Field
The radiation field for thoracic radiotherapy can be summarized in a simplified list as follows:
Sood says this is worth memorizing because it corresponds to what is Limited stage
- Target Volume Components:
- Gross tumor volume (GTV) as defined by chest CT scan.
- Bilateral mediastinal lymph nodes.
- Ipsilateral hilar lymph nodes.
- Excluded Areas:
- No irradiation of uninvolved supraclavicular fossae.
- Borders:
- Inferior border extends 5 cm below the carina or to the level including ipsilateral hilar structures, whichever is lower.
- Margins:
- The clinically determined volume is expanded by a margin of 1 to 1.5 cm to account for microscopic disease spread and planning uncertainties.
This approach ensures coverage of the visible tumor and involved lymph nodes while sparing uninvolved regions such as the supraclavicular fossae, with a safety margin to encompass potential microscopic disease
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Cord Constraint
Dmax 36Gy?? in the BID arm
for 1 week field covered the cord, then use of obliques
VALSG Definition of LS-SCLC
- Disease Extent:
Confined to 1 hemithorax, including the primary tumor and ipsi mediastinal and SCV lymph nodes.
- Lymph Node Involvement:
Only ipsi mediastinal and SCV nodes included.
- Malignant Pleural/Pericardial Effusions:
Sometimes included in LS per original VALSG, though often considered ES in practice.
- Radiation Therapy Feasibility:
Disease can be encompassed within a single, tolerable radiation therapy field.
- Contralateral Nodal Disease:
Considered ES and excluded from LS.
- Granularity of Staging:
Binary system dividing SCLC into LS and ES.
- Basis of Definition:
Practical feasibility of delivering radiation treatment within 1 hemithorax.
International (IASLC/TNM-based) Definition of LS-SCLC
- Disease Extent:
Corresponds to TNM stages 1–3 (any T, any N, M0), meaning no distant metastases.
- Lymph Node Involvement:
Includes some contralateral mediastinal and SCV nodes if disease can be safely encompassed by radiation therapy.
- Malignant Pleural/Pericardial Effusions:
Generally excluded from LS; considered ES.
- Radiation Therapy Feasibility:
Disease must be safely treatable within a radiation field.
- Contralateral Nodal Disease:
May be included in LS if treatable with radiation.
- Granularity of Staging:
More detailed TNM staging system (1–3 as LS, 4 as ES).
- Basis of Definition:
Anatomical TNM staging combined with radiation treatment feasibility.
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