For ultracentral lung cancer abutting the heart, what dose constraints would you use for the heart and bronchus if using 10 fraction ultrahypofractionation?

NCCN guidelines allow the heart to get 105% of PTV prescription for 5 fractions to 55 Gy, but Timmerman tables from 2021 state the heart should be below 42.5 Gy for 10 fraction treatment.

Answer from: Radiation Oncologist at Academic Institution

The dose deviation from Timmerman for the heart is 60 Gy in 10 fractions. Now that they are published, I'd utilize the SUNSET constraints. Patients received 60 Gy/8 fractions (rather than the 10 fraction regimens questioned here) but the best data we have to extrapolate and use constraints that are ...

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Radiation Oncologist at Lexington Clinic
Thank you!

Radiation Oncologist at Mon Health
Would the CALGB regimen of 70 Gy in 17 fractions b...

Answer from: Radiation Oncologist at Academic Institution

For "intra-central lung cancer” that closes or abuts the heart or bronchial tree, we could potentially treat with 70 Gy in 10 fractions with SIB GTV to 80 Gy. We typically keep heart Dmax<60 Gy, V50 Gy < 1cc; bronchial tree Dmax <60 Gy, and V50 < 1 cc. We understand this is a conse...

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For ultracentral lung cancer abutting the heart, what dose constraints would you use for the heart and bronchus if using 10 fraction ultrahypofractionation?

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