What ITV to PTV expansions do you use for free-breathing NSCLC SBRT using CT sim with 4DCT?
Answer from: Radiation Oncologist at Academic Institution
5mm concentric PTV margins. Even with daily IGRT and fluoro, I find 3mm to be very tight and adding a little more margin does not change the OAR doses much unless PTV is touching. If 4DCT not available in sim, I do 7mm sup/inf and 5mm in other directions.
I do not specifically add a CTV margin, but...
Answer from: Radiation Oncologist at Community Practice
To be a stickler for terminology, PTV expansions should be based on uncertainty. My default is 5 mm although would consider 3 mm in certain (limited) circumstances. Discuss with your physicists based on your treatment machine, immobilization, and IGRT strategies. You can consider increasing your PTV...
Comments
Radiation Oncologist at Yale School of Medicine Agree. My above reasoning combines the considerati...
Radiation Oncologist at Cleveland Clinic Agree with Dr. Kittel's answer. Almost alway...
Answer from: Radiation Oncologist at Community Practice
My default expansion from IGTV to PTV is 7 mm concentrically. However, these margins can be customized to as little as 4 mm or as much as 10 mm in certain directions based on several considerations. These include:
(1) proximity of the IGTV to chest wall or critical central structures (typically wil...