2.0 f02ae36c-7a64-4681-96c3-3cbeea92d85a *AOS_Lung_L convfx 60Gy 30fx v1 Thorax Lung Left *AOS_Lung_L convfx 60Gy 30fx AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: 30 fx left lung conventional fx to 60 Gy References: ARTIA-Lung, "Daily Adaptive Radiation Therapy: An Individualized Approach for Stage III Lung Cancer (ARTIA-Lung)"; RTOG 1306, "A Randomized Phase II Study of Individualized Combined Modality Therapy for Stage III Non-Small Cell Lung Cancer (NSCLC)" Version 1.4 Created: 2/11/2025 (PHH) copied from right lung Last updated: 4/18/2025 (PHH) - Adjusted influencer Priorities and sub-P ordering, corrected OAR label (Bronchus_Main) ********************************************************************* Rx: "The total dose will be 60 Gy in 30 fractions of 2 Gy. The treatment plan will be normalized such that 95% of the PTV is covered by the prescription dose. No more than 0.03 cc of the PTV may receive > 120% of the prescription dose (maximum dose constraint). The maximum and minimum doses within the PTV (defined as the minimum dose to the hottest 0.03 cc volume and the maximum dose to the coldest 0.03 cc volume, respectively) will be reported." - RTOG 1306 "The prescribed dose can cover less than 95% of the PTV provided it covers at least 90% of the PTV. The minimum dose can fall below 93% of the prescribed dose provided it is at least 90% of the prescription dose, if the areas of underdosing are confined to regions of overlap with critical structures. The maximum dose within the PTV may exceed 120% of the prescribed dose provided it is no more than 125% of the prescription dose, and the areas exceeding 110% of the prescription dose are confined within the GTV and do not overlap with critical structures." - RTOG 1306 Target Contouring: "The primary tumor and clinically positive lymph nodes seen either on the pretreatment or the planning CT (> 1 cm short axis diameter) or pretreatment PET scan (maximum SUV > 3) will constitute the GTV. Pathologically involved nodes not meeting radiographic criteria also should be included in the GTV" -RTOG 1306 Target Margins: "The CTV is defined to be the GTV plus a 0.5 cm to 1 cm margin as appropriate to account for microscopic tumor extension. However, the CTV should not cross natural anatomic barriers to tumor extension such as fissures or fascial planes unless these structures are directly abutted or invaded by the GTV." - RTOG 1306 "The internal target volume (ITV) is defined to be the CTV plus an internal margin (IM) to account for target/organ motion. The final PTV is defined to be the ITV plus a setup margin (SM) to account for patient positioning uncertainty and machine tolerance." -RTOG 1306 OAR Contouring: "Critical structures should be contoured according to the lung contouring atlas." - RTOG 1306 See RTOG 1306 Section 6.5 for further OAR contouring information. OAR Constraints: " * Spinal cord: Maximum dose ≤ 52 Gy. * Lungs: V20 ≤ 40%, MLD ≤ 22 Gy (after all strategies described in section 6.5.2 have been attempted). * Esophagus: Maximum dose ≤ 66 Gy, mean dose ≤ 35 Gy. It is recommended that circumferential irradiation to > 60 Gy for no more than 0.5 cm length (e.g., if the CT slice spacing is 0.3 cm, the 60 Gy isodose line may encompass the cross-section of the esophagus on one slice but not on any adjacent slices.) * Brachial plexus: Maximum dose ≤ 66 Gy." -RTOG 1306 "Normal tissue constraints shall be prioritized in the following order for treatment planning: 1=spinal cord, 2=lungs, 3=esophagus, 4=brachial plexus, and 5=heart." - RTOG 1306 ** See RTOG 1306 Table 6.7.1 for further PTV and OAR constraints. ** Additional OAR contraints and objectives are based on clinical judgment. Structures have been named according to TG 263 as opposed to the DICOM Standard recommended by RTOG 1306. 5018 FMA 3.2 Bones 4289396157 Bones 7088 FMA 3.2 Heart 4294957055 Heart 7131 FMA 3.2 Esophagus 4289068874 Esophagus 7309 FMA 3.2 Lung right 4278190284 Lung_R 7310 FMA 3.2 Lung left 4294967040 Lung_L 45245 FMA 3.2 Brachial plexus left 4294934720 BrachialPlex_L 45244 FMA 3.2 Brachial plexus right 4286578943 BrachialPlex_R T-D3219 SRT Great vessels of the heart 4291454208 GreatVes 7394 FMA 3.2 Trachea 4278190335 Trachea 264793 FMA 3.2 Set of left ribs 4278223103 Ribs_L 264792 FMA 3.2 Set of right ribs 4291624908 Ribs_R 7163 FMA 3.2 Skin 4286644096 Skin Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items 5 0 ]]> 7148 FMA 3.2 Stomach 4294934720 Stomach 9869 FMA 3.2 Pericardium 4294901888 Pericardium 7197 FMA 3.2 Liver 4278206464 Liver 7405 FMA 3.2 Main bronchus 4289986559 Bronchus_Main 68877 FMA 3.2 Both lungs 4294934528 Lungs 7647 FMA 3.2 Spinal cord 4278255615 SpinalCord GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume 4285868492 GTV ITV 99VMS_STRUCTCODE 1.0 Internal target volume 4294934528 ITV R-429EC SRT Planning target volume 4294901760 PTV Target2 ITV 99VMS_STRUCTCODE 1.0 Internal target volume 5 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> R-429EB SRT Clinical target volume 4280918220 CTV Target1 GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume 5 ]]> HealthyTissue 99VMS_STRUCTCODE 1.0 Generic healthy tissue 4278933393 Lungs-GTV OAR5 7310 FMA 3.2 Lung left OAR4 7309 FMA 3.2 Lung right Target1 GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume ]]> Target3 2 VolumeDose ShouldBeMoreOrEqual 95 Relative 60 Absolute VolumeDose ShouldBeMoreOrEqual 90 Relative 60 Absolute 1 1 DoseVolume ShouldBeMoreOrEqual 99 Relative 56 Absolute DoseVolume ShouldBeMoreOrEqual 99 Relative 54 Absolute 2 1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 120 Relative DoseVolume ShouldBeLessOrEqual 0.03 Absolute 125 Relative 2 10 OAR2 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 2 8 OAR2 DoseVolume ShouldBeLessOrEqual 15 Absolute 45 Absolute 2 4 OAR2 MeanDose OAR3 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 63 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 2 7 OAR3 MeanDose ShouldBeLessOrEqual 34 Absolute MeanDose ShouldBeLessOrEqual 35 Absolute 2 5 OAR6 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 63 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 3 6 OAR7 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 63 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 3 7 OAR8 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 3 3 OAR8 VolumeDose ShouldBeLessOrEqual 10 Absolute 45 Absolute 3 1 OAR9 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 3 4 OAR10 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 4 1 OAR11 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 4 2 OAR12 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 55 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute 4 3 OAR12 DoseVolume ShouldBeLessOrEqual 10 Absolute 49 Absolute DoseVolume ShouldBeLessOrEqual 10 Absolute 54 Absolute 4 4 OAR13 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 45 Absolute 4 5 OAR13 MeanDose OAR14 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 2 9 OAR14 DoseVolume ShouldBeLessOrEqual 15 Absolute 45 Absolute 2 6 OAR14 MeanDose OAR15 DoseVolume ShouldBeLessOrEqual 700 Absolute 25 Absolute 3 5 OAR15 MeanDose OAR16 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 3 2 ControlRegion1 MeanDose ShouldBeLessOrEqual 20 Absolute MeanDose ShouldBeLessOrEqual 22 Absolute 2 3 ControlRegion1 VolumeDose ShouldBeLessOrEqual 37 Relative 20 Absolute VolumeDose ShouldBeLessOrEqual 40 Relative 20 Absolute 2 2 OAR18 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50.5 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 52 Absolute 1 2 OAR4 MeanDose OAR5 MeanDose NoNormalization 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None