When contouring locally advanced NSCLC, how do you define your ITV if your iGTV overlaps with an OAR?  

For locally advanced lung, I have 2 slightly different approaches for primary vs nodes. For primary, GTV to iGTV (with 4DCT or DIBH scans x 3 at sim in certain cases) to CTV (5 mm expansion cropped to anatomical barriers to spread) to PTV (5 mm uniform expansion). I let the iGTV overlap the esophag...

I agree with Dr. @Whitaker. It's so tempting to crop your ITV/iGTV out of OARs but it's a bit of a cheat. I also accommodate my CTV when it makes sense but double-check the 4D loop bc there's usually some motion of the nodes and you can undercover the iGTV accidentally if you just use the averaged s...

I never crop the IGTV, as that would violate fundamental principles of radiation therapy planning. I also never crop the PTV for similar reasons. Instead, I work with my planning team to minimize the Dmax in the overlap area. Thanks. 

Agreed with the above answers. Cropping out of the OAR would risk not adequately dosing your gross disease which is not the correct move. While tempting as we wish to limit toxicity, it is imperative to not miss when you are going for the definitive treatment. If the concern is the esophagus or exce...