Lung Cancer Radiotherapy Flashcards
Planning Volumes
OAR on AVG GTV on MIP (maximum intensity projection) CTV 0.5cm expansion PTV 0.7 with 0.9 sup inv 3D scan PTV 1cm + 1.3 sup and inf SABR 0.5cm from GTV to PTV (no CTV)
Small Cell
MRI for brain mets- definitely prior to concurrent and with nodal disease
Concurrent <75
Planning after C1 with C2
Torizi twice daily 45 in 25
Sequential is PS 2 Renal function Vascular risk >30 crcl can use carboplatin if poor 55 in 20# if poor response otherwise 50 in 20#
PCI good response PS 0-1 no prior brain disease and after completing chemotherapy. 25 in 10#. Can be done with other RT if no concurrent chemo.
Stage IV PE. Role for PCI and consolidation RT if response.
20 in 5 to brain. REST trial. 30 in 10 to chest.
Limited stage drop in 50% local control to chest.
Extensive stage 3 months up to a year with treatment.
Non Small Cell
Stage 1 -
Surgery
SABR >2cm primary bronchi. Secondary division of main 6 areas. Due to tracheal necrosis.
Stage 2
If nodes or >5cm not SABR
Radical RT or surgery
55 in 20# but can use 15# hypofraction.
Stage 3
Single station - surgeons consider resection. EBUS of all LN and MR brain.
Otherwise chemo/rt
PFTs/ MR
Sequential or concurrent (better more toxic)
Cis/Etop
T4 vascular not for concurrent given bleeding risk.
Paul Taylor referral with booking form in place for concurrent. 3/52 Jacqui feminal letter as well. Provisional start date. Paul verifies for concurrent.
Seq. gem/carbo with CT following 3rd cycle
3b grouped with stage 4 and not treatable. Adeno/large Cell. EGFR/ALK/PDL1. >50% pembrolizumab. ROS1 similar to ALK.
Adeno. Fit STD pem/cis + pem maintenance. Pem/carbo no pem.
Folic acid and VIT B12 pretreat. Premed Dex. Scan after 3 cycles. Palliative XRT if symptomatic.
ScC gem/carbo with no maintenance. Palliative. Breathlessness, cough, bleeding and pain. 10/5/1 #
Gem Carbo
Dose cap 500 for carbo
Wedge angle hinge
Wedge angle= 90- (hinge angle/2)
