Lisa Stevenson

Fieldwork Lab 1
NSCLC RTOG 0893
This patient has a stage IIIa right lung mass that was simulated using a free breathing
technique. The physician requested this plan to be done via a VMAT technique and for the
patient to have daily IGRT. Therefore the tumor margins were created in compliance with the
protocol parameters for the Free Breathing CT + Free Breathing Treatment +Daily IGRT. The
physician contoured the GTV based on a PET/CT fusion. The CTV was then constructed by
expanding the GTV 1cm sup/inf and .5cm axially. The CTV was then expanded 1.2cm sup/inf
and .7cm axially to create the PTV.
Then, I proceeded to contour the esophagus, brachial plexus, bilateral lungs, heart, spinal
cord, right lung, and left lung.(Figure 3.) Three rings and a normal tissue contour were also
added to assist in faster dose fall off. I then ran comparison plans between a 9 field IMRT and a
VMAT plan with 2 arcs that started at 188 and stop at 100. I chose a beam energy of 6MV which
is required for all VMAT plans at GHCI due to the neutron contamination that occurs higher
energies. The VMAT plan had slightly better coverage and had a tiny 107% hot spot as opposed
to the 111% hot spot provided by the IMRT. The dose to the organs at risk were very comparable
between the two plans. I chose the VMAT plan because of the slightly better PTV coverage as
well as the shorter treatment time which limits patient movement during treatment. (Figure 2.)
My objectives included a minimum of 100% of the prescription dose to be delivered to the PTV
and also added objectives to limit dose to the cord, esophagus, and used the rings to start limiting
dose to the normal lung and brachial plexus.
I was able to meet all planning objectives very well with the VMAT technique. The plan
was well under the maximum allowable dose levels for all ORs and I had adequate coverage of
the PTV. I did have try multiple avenues to get a minimum of 95% of the prescription dose to
cover the PTV that was in air. This coverage was finally achieved through a variety of fills
which are essentially contours that represent the areas of the PTV outside of the 95% isodose
line. I then put these fill ROIs in my planning objectives to a minimum dose of 6000cGy and
weighted this objective very heavily.

Planning objectives reached for a prescribed dose 6000cGy delivered in 30 factions of

200cGy per day include:
OR

Desired Objective

Achieved Objective

Brachial Plexus

<66 Gy max

5.4Gy max

Lungs

<20Gy mean

11.6 Gy mean, v20 is 20.7%

Esophagus

<40 Gy mean

15.4 Gy mean

Spinal Cord

<50.5 Gy max

16.3Gy max

Heart

<40 Gy 100% vol

4.39 mean

PTV

<57 Gy , >72Gy

Min 57 Gy, Max 66Gy

Figure 1 : DVH

Figure 2: Beam Orientation

Figure 3: Targets and ORs:

PTV
CTV
GTV