2.0 d792f155-a8cb-4b4e-b7a9-c7f9b4c042a8 *AOS_Lung_L peripheral SBRT 54Gy 3fx v1 Thorax Lung Left *AOS_Lung_L peripheral SBRT 54Gy 3fx AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: 3 fx left peripheral lung SBRT to 54 Gy Reference: RTOG 1021, "A Randomized Phase III Study of Sublobar Resection (+/- Brachytherapy) versus Stereotactic Body Radiation Therapy in High Risk Patients with Stage I Non-Small Cell Lung Cancer (NSCLC)" Version 1.6 Created: 10/4/2024 Last updated: 4/18/25 (PHH) - Adjusted sub-P ordering of objectives, corrected OAR label (Bronchus_Main) ********************************************************************* Rx: "Patients will receive 3 fractions of radiation. The dose for all patients will be 18 Gy per fraction to the prescription line at the edge of the PTV (total dose = 54 Gy). All treatment must be completed within 16 days. The time between fractions is at the discretion of the investigator, but a minimum of 40 hours and a maximum of 8 days should separate each treatment. No more than 2 fractions will be delivered per week (7 consecutive days)." - RTOG 1021 "The prescription isodose surface will be chosen such that 95% of the target volume (PTV) is conformally covered by the prescription isodose surface of 54 Gy and 99% of the target volume (PTV) receives a minimum of 90% of the prescription dose (i.e., 48.6 Gy)." - RTOG 1021 Normalization: "The treatment plan should be normalized such that 100% corresponds to the center of mass of the PTV" - RTOG 1021 PTV Margins: "An additional 0.5 cm in the axial plane and 1.0 cm in the longitudinal plane (craniocaudal) will be added to the GTV to constitute the PTV." - RTOG 1021 Additional details - see RTOG 1021 Section 5.3.4.1 pp. 19-20. Dose Falloff: "a) Location: Any dose > 105% of the prescription dose should occur primarily within the PTV itself and not within the normal tissues outside the PTV. Therefore, the cumulative volume of all tissue outside the PTV receiving a dose > 105% of prescription dose should be no more than 15% of the size of the PTV volume. b) Volume: Conformality of PTV coverage will be judged such that the ratio of the volume of the prescription isodose meeting criteria 1 through 4 to the volume of the PTV is ideally < 1.2 (see table below)." - RTOG 1021 "The falloff gradient beyond the PTV extending into normal tissue structures must be rapid in all directions and meet the following criteria: a) Location: The maximum total dose over all 3 fractions in Gray (Gy) to any point 2 cm or greater away from the PTV in any direction must be no greater than D2cm where D2cm is given by the table below. b) Volume: The ratio of the volume of the 27 Gy isodose volume (50% of the prescription dose) to the volume of the PTV must be no greater than R50% where R50% is given by the table below." -RTOG 1021 OAR Constraints: See RTOG 1021 Section 5.3.5.1 p.22. OAR Contouring: See RTOG 1021 Section 5.3.5.2 p. 23. Structures have been named according to TG 263. 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 7465 FMA 3.2 Carina 4281018828 Carina GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume 4285868492 GTV primary 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 ]]> HealthyTissue 99VMS_STRUCTCODE 1.0 Generic healthy tissue 4278190208 Lungs-ITV OAR4 7310 FMA 3.2 Lung left OAR3 7309 FMA 3.2 Lung right Target1 GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume Target2 ITV 99VMS_STRUCTCODE 1.0 Internal target volume OAR15 7405 FMA 3.2 Main bronchus ]]> Target3 18 DoseVolume ShouldBeMoreOrEqual 95 Relative 54 Absolute 1 1 DoseVolume ShouldBeMoreOrEqual 99 Relative 48.6 Absolute 2 1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 140 Relative 3 9 OAR1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 30 Absolute 3 2 OAR1 VolumeDose ShouldBeLess 15 Absolute 24 Absolute 3 1 OAR1 MeanDose OAR2 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 25.2 Absolute 3 8 OAR2 VolumeDose ShouldBeLess 5 Absolute 17.7 Absolute 3 7 OAR2 MeanDose OAR3 MeanDose OAR4 MeanDose OAR5 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 24 Absolute 3 12 OAR5 VolumeDose ShouldBeLessOrEqual 3 Absolute 20.4 Absolute 3 13 OAR6 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 24 Absolute 3 14 OAR6 VolumeDose ShouldBeLess 3 Absolute 20.4 Absolute 3 15 OAR7 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 45 Absolute 3 6 OAR7 VolumeDose ShouldBeLess 10 Absolute 39 Absolute 3 5 OAR8 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 30 Absolute 3 16 OAR8 VolumeDose ShouldBeLess 4 Absolute 15 Absolute 3 17 OAR9 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 36.9 Absolute 4 1 OAR9 VolumeDose ShouldBeLess 1 Absolute 28.8 Absolute 4 2 OAR10 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 36.9 Absolute 4 3 OAR10 VolumeDose ShouldBeLess 1 Absolute 28.8 Absolute 4 4 OAR11 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 33 Absolute 4 5 OAR11 VolumeDose ShouldBeLess 10 Absolute 30 Absolute 4 6 OAR12 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 22.2 Absolute 3 11 OAR12 VolumeDose ShouldBeLess 10 Absolute 16.5 Absolute 3 10 OAR12 MeanDose OAR13 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 30 Absolute 3 4 OAR13 VolumeDose ShouldBeLess 15 Absolute 24 Absolute 3 3 OAR13 MeanDose OAR14 DoseVolume ShouldBeLessOrEqual 700 Absolute 17.1 Absolute 3 18 OAR14 MeanDose OAR15 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 30 Absolute 3 19 OAR15 VolumeDose ShouldBeLess 4 Absolute 15 Absolute 3 20 OAR17 VolumeDose ShouldBeLess 0.3500000000000001 Absolute 18 Absolute 2 4 OAR17 VolumeDose ShouldBeLess 1.2 Absolute 12.3 Absolute 3 21 OAR17 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 21.9 Absolute 2 5 ControlRegion1 DoseVolume ShouldBeLessOrEqual 1500 Absolute 10.5 Absolute 2 2 ControlRegion1 DoseVolume ShouldBeLessOrEqual 1000 Absolute 11.4 Absolute 2 3 ControlRegion1 MeanDose NoNormalization 1 None 1 None 1 None