Cyberknife target delineation for early non-small cell lung cancer

1.
Preparation for CT localization of non-small cell lung cancer

A gold label was placed in the lesion 1 week before the patient was positioned
.

The patient undergoes radiosurgery and is positioned using body pads or chest nets
.

Try to use enhanced CT scan positioning
.

Schematic diagram of gold label placement

2.
CT positioning requirements

1.
Position of the patient: supine position, with both upper limbs placed on both sides of the body or holding the head
.

2.
Respiratory phase: free breathing at the end of expiration
.

3.
Scanning layer thickness: 1.
5mm.

4.
Scanning range: 15cm above and below the lesion.

3.
Normal organs delineated by radiosurgery for non-small cell lung cancer

Both lungs

1.
Draw the lungs under the lung window
.

2.
All the lungs with inflammation, fibrosis and atelectasis should be outlined, and the small blood vessels in the hilar area should also be included
.

3.
Trachea/bronchi and GTV should not be included
.

4.
PET/CT can help to distinguish between non-expansion of the lung and GTV
.

esophagus

1.
Delineate the esophagus under the mediastinal window
.

2.
Including mucosa, submucosa, muscularis and adventitia
.

3.
Scope: 10cm above and below the PTV (exceeding the cricoid cartilage and the esophagogastric junction will terminate at these structures)
.

Proximal Bronchial Tree (PBT)

1.
Draw PBT under the mediastinal window
.

2.
Scope: proximal 2cm trachea, carina, main bronchus, right upper, middle and lower lobe bronchus, left upper, lower lobe and lingual bronchus
.

3.
Including the mucosa, submucosa, cartilage ring and airway corresponding to these structures
.

trachea

1.
Delineate the trachea under the mediastinal window
.

2.
Including mucosa, submucosa, cartilage ring and airway
.

3.
Range: 10cm on the PTV or 5cm on the carina (whichever is higher)
.

spinal cord

1.
Delineate the spinal cord according to the bony landmarks of the marrow cavity
.

2.
Scope: 10cm above and below the PTV (exceeding the base of the skull and L2 will terminate at these structures)
.

Brachial plexus

1.
The lesion is located in the upper lobe, and the patient needs to outline the brachial plexus, just outline the same side
.

2.
Range: C4-C5 to T1-T2 level nerve foramen of the spinal cord, to the termination of the subclavian vascular nerve bundle
.
(Remarks: There is no level of the nerve foramen.

Heart and blood vessels

1.

2.

3.

Chest wall

1.

2.

3.

4.

5.

Note: (1) 66Gy/8 times in the hilar; (2) 60Gy/3 times in the peripheral type; (3) 60Gy/6 times in the adjacent brachial plexus; (4) 60Gy/5 times close to the chest wall

references:

[1] Yuan Shuanghu, Editor-in-Chief Song Qibin.