What CTV expansions do you use for NSCLC with conventional chemoradiation and do you do different expansions based on specific histologies?
Some references and papers suggest 8 mm for adenocarcinoma and 6 mm for squamous cell carcinoma (Giraud et al., PMID 11072158). RTOG 1308 used 8 mm but other protocols use 5 mm.
Answer from: Radiation Oncologist at Academic Institution
We do 5 mm for all chemoRT cases and do not alter based on histology.
Answer from: Radiation Oncologist at Academic Institution
I currently use 0 mm for all thoracic XRT cases. This is whether prescribing SBRT, Hypofx RT, Conventional RT, or CRT. I'm comfortable omitting a CTV as we have a state-of-the-art CT simulation system showing a lot of historically invisible fuzz. I make sure to include "all the fuzz" around a tumor ...
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Radiation Oncologist at Hôtel Dieu de Lévis - CISSS Chaudière-Appalaches Very interesting approach! Do you have any data to...
Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System Sure. The data I rely on was published in 2019 by ...
Radiation Oncologist at Hôtel Dieu de Lévis - CISSS Chaudière-Appalaches Amazing! Thanks for sharing!
Radiation Oncologist at Rad Onc Assoc PC I view CTV as clinical microscopic spread and hist...
Radiation Oncologist at Mayo Clinic I think "conventional wisdom" is what a lot of tho...
Radiation Oncologist at Hôtel Dieu de Lévis - CISSS Chaudière-Appalaches Great points Dr. @Kenneth Olivier! Maybe the ITV b...
Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System I've learned about the 15-degree couch-kick strate...
Radiation Oncologist at Mayo Clinic @Drew Moghanaki that made me LOL. I've had those s...
Radiation Oncologist at UC San Diego School of Medicine Also, this paper is supportive - Kilburn et al., P...
Answer from: Radiation Oncologist at Academic Institution
CTVs are cool things IMO. They aren't so easy to derive and are a mix of pathologic data and patterns of failure (if they are data-driven in their derivation). It's one of the few things that AI won't easily do for us since it's not radiomics per se... but I digress. :) The best paper is the pa...
Answer from: Radiation Oncologist at Community Practice
Interesting discussion. Thanks to all who have weighed in already.
I don't think you can discuss CTV expansion out of context without considering the PTV expansion, IGRT method, 3D vs 4D sim, 3D vs 4D couch corrections, etc.
For example, a larger PTV expansion will make up for a smaller CTV ...
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Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System There's a rationale behind having separate CTV and...
Answer from: Radiation Oncologist at Academic Institution
Also, Cui et al., PMID 36764460: A prospective phase II randomized study, randomizing to CTV creation or no CTV creation supports lower toxicity and equal control and survival without creation of CTV. I generally avoid it in large-volume tumors but in small tumors where we will achieve reasonable lu...