Hybrid MEDIASTINAL MASS

This patient presented with a T4N3M0 adencarcinoma of the left lung. The mediastinal mass showed compression of the mid esophagus.  There was also some contralateral right hilar node involvement.  The physician planned to treat 39.6 Gy /22fxs followed by a boost of 23.4 Gy/13fxs to a total dose of 63Gy.
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For the initial hybrid to 39.6Gy I did Ap/Pa lung with 10mv and a 7mm margin around the PTV.   For the Vmat portion of the plan, I did 2 complete arcs with 75 degree avoidances laterally. The magenta line represents the bilateral lung dose and the orange line shows the cord dose.

Typically, you cannot do a hybrid boost due to the heart. But in this case the heart is below the treated area. I used the same beam arrangement and weighting, and varied my avoidance area slightly (matter of choice).

This is the sum DVH. This technique is very impressive. The white line is just 10Gy! Give it a try in your clinic....