How do you construct your target volumes for superior sulcus tumors?

This is one of my favorite topics, so I apologize in advance for my verbosity.

1. Tumors invade: I worry that our RT fields, in general, are getting too tight (i.e., cancer often invades beyond what we can see on our imaging, and our CTV margins are often small). This is especially true for Pancoast tu...

These are typically tri-modality cases and I usually stop at 45-50 Gy, but if treating definitively.

I would simulate with 4D and contour a GTV-ITV and add 0.5 cm CTV expansion, carving out of uninvolved bone/muscle. Then, I'd add 0.5 cm PTV expansion.

Unless it is T4 and invading vertebra, I have ...