Cyberknife target delineation for early non-small cell lung cancer

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

1.
Preparation for CT localization of 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

2.
CT positioning requirements 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

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

Both lungs

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
.

Blood vessel

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)

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

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

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

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.

Delineate the gap or soft tissue between the anterior and middle scalene muscles

 

Heart and blood vessels

Heart and blood vessels

1.

Under the mediastinal window, the heart is delineated along the package, and the blood vessels cover the entire muscular layer of the vessel wall to the fatty adventitia

2.

3.

 

Chest wall

Chest wall

1.

2.

3.

 

4.

4.

 

5.

V.

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

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.

[1] Yuanshuang Hu, Song Qibin editor tumor.
Precision radiotherapy target delineation map [M].
Wuhan: Hubei Science and Technology Press .
2018 accurate in this message