Lung IMRT Guidelines   from Practical Essentials of Intensity Modulated Radiation Therapy, second edition, ed K.S. Clifford Chao

Target Volume Delineation

  • GTV is any visible tumor and nodes over 1 cm
  • CTV = GTV + 6mm (squamous) and 8mm (adenocarcinoma) (to account for microscopic spread)
  • PTV = CTV + 8 - 12mm (to account for tumor motion and set up uncertainty, because tumors can move up to 8.3mm respiratory gaiting is used if possible)
Suggested Target and Normal Tissue Dose
  • achieve tumor dose coverage at the prescription dose
  • maximum spinal cord dose 45Gy
  • limit the V20 to less than 40% of total lung volume for patients receiving RT alone
  • limit the V20 to less than 35% for patients receiving chemoradiation alone
  • limit the V20 to less than 20% when chemoradiation is followed by surgery (and keep V10 below 40%)
  • limit heart V50 to less than 50%
  • limit the length of the esophagus to less than 16 cm receiving 60Gy

V20 = volume receiving 20Gy