PERIPHERAL LESION LUNG SBRT ROSE CASE PPT

PERIPHERAL LESION LUNG SBRT ROSE CASE PPT

1. SBRT LUNG ROSE CASE R ADIATION O NCOLOGY S IMULATION TO E XECUTION SBRT LUNG PERIPHERAL LESION ADJACENT TO VESSEL Dr Dona Treesa Vincent Dr Kanhu Charan Patro MD,DNB(Radiation Oncology),MBA,FICRO,FAROI(USA),PDCR,CEPC Clinical Director, HOD (Radiation Oncology) ISRo - I nstitute of S tereotactic R adiation o ncology Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam [email protected] /M- [phone]/ www.drkanhupatro.com

2. 73 year old male Chronic smoker, chronic alcoholic and khaini chewer C/O shortness of breath since 2-3 years, progressively increased, aggravated since 4-5 months Hypertensive on medication No other significant medical / surgical / family history HISTORY

3. Routine blood tests – normal PFT- Mild Restrictive, Moderate Obstructive 2D ECHO G- 1 LV dysfunction EF- 65% INVESTIGATIONS

4. CECT thorax 2-8 * 2.9 *2.4 cm lesion over Right Lung Bilateral emphysematous changes in both lungs No significant mediastinal nodes PET CT 2.5* 3.6 cm lesion in Right Lung with SUV max 10.1 INVESTIGATIONS

5. CT GUIDED BIOPSY s/o Non Small Cell Lung Cancer, morphologically favors Adenocarcinoma INVESTIGATIONS

6. LOCATION SIDE LOBE Right Upper STAGE T N M cT2a cN0 M0 STAGE GROUP IB MOTION ASSESSMENT Symmetry TYPE OF LOCATION Peripheral PATIENT DEMOGRAPHY

7. Line of treatment Surgery vs Stereotactic Body Radiation Therapy (SBRT)

8. Tumor board decision After group discussion with Surgical Oncologist, Medical Oncologist , radiation oncologist and patient, board decided to plan for stereotactic radiotherapy since the patient is not fit due to age and comorbidities.

9. Patient discussion Discussed about RT comparing with surgery Discussed about the procedure Discussed about imaging and follow up Discussed about tumor response Discussed about post radiotherapy side effects RIB FRACTURE

10. Dose selection NCCN GUIDELINES VERSION 7.2024 NSCLC

11. Radiation tumor board Planned for SBRT Dose- 58 - 60Gy in 8 Fractions adjacent to vessel

12. IMMOBILIZATION VACLOCK HANDS ABOVE THE HEAD

13. Planning CT 3mm Slice Contrast Neck to Umbilicus

14. SYMMETRY SCAN

15. Motion assessment by Symmetry Video Movement is less than 5mm So we didn't use any motion Mx protocol

16. Target delineation

17. GTV IN SOFT TISSUE WINDOW

18. GTV IN LUNG WINDOW

19. PTV 0.7 mm

20. DOSIMETRIC SYMMETRY SCAN VIDEO

21. OAR- CHEST WALL

22. OAR- GREAT VESSELS- PRV

23. OAR- TOTAL LUNG

24. DOSE VOLUME HISTOGRAM

25. TARGET COVERAGE INDEX WE HAVE ACCEPTEDSLIGHTLY LESS DOSE TO PTV AS ADJACENT TO VESSEL

26. RTOG conformity index FORMULA VOLUME OF PRESCRIPTION ISODOSE/PTV VOLUME 84.35/80.16 = 1.05 DESIRABLE=1 [Sonja Petkovska Proceedings of the Second Conference on Medical Physics and Biomedical Engineering]

27. Paddick conformity index FORMULA (VOLUME OF PRESCRIPTION ISODOSE IN AREA OF INTEREST) 2 PTV VOLUME X VOLUME OF PRESCRIPTION ISODOSE 76.1*76.1 /84.35* 80.38 = 0.856 IDEAL=  > 0.85. AND <1 Michael Torrens,/J Neurosurg ( Suppl 2)/2014

28. CONSTRAINTS

29. OAR DOSE CONSTRAINTS

30. ISODOSE LINE

31. BEAM ARRANGEMENT

32. ROOMS EYE VIEW

33. QA Part MECHANICAL ISOCENTER CHECK WINSTON LUTZ TEST POINT DOSE VERIFICATION TOLERANCE-1MM

34. Dry run

35. Set Up Reproduce the positioning same as during planning CT VACLOCK HANDS ABOVE HEAD MATCHING LASERS HEXAPOD

36. Set Up Verification- CBCT correction

37. Set-up verification – Hexapod correction

38. Pre medication-optional TAB. DEXAMETHASONE 8MG THRICE DAILY STARTING DAY BEFORE TAB. PAN 4O ONCE DAILY STARTING DAY BEFORE DIABETES CARE IF PAIN CARE

39. Post medication-optional TAPER THE STEROID OVER A WEEK PPI

40. Advice IMAGING AFTER 3 MONTHS NO IMMUNOTHERAPY/TARGETED AGENTS FOR 1-3 MONTHS

41. SBRT LUNG FROM THE DEPARTMENT OF RADIATION ONCOLOGY ISRo - I nstitute of S tereotactic R adiation o ncology Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam [email protected] /M- [phone]/ www.drkanhupatro.com