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A. A., male ,71y

A. A., male ,71y. History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3. A. A., male ,71y. History:

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A. A., male ,71y

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  1. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3

  2. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage:

  3. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage: T2 Nx M0 Tumorboard:

  4. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage: T2 Nx M0 Tumorboard: -inoperable because of vascular disease (medically inoperable) and because of poor lung function (FEV1 1.4 l) -

  5. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage: T2 Nx M0 Tumorboard: -inoperable because of vascular disease (medically inoperable) and because of poor lung function (FEV1 1.4 l) -radical RT alone without ChT because of vascular disease and age Prescription of dose and RT planning:

  6. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage: T2 Nx M0 Tumorboard: -inoperable because of vascular disease (medically inoperable) and because of poor lung function (FEV1 1.4 l) -radical RT alone without ChT because of vascular disease and age Prescription of dose and RT planning: 32 x 2 Gy = 64Gy in 1 series Target-Volume:

  7. A. A., male ,71y

  8. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage: T2 Nx M0 Tumorboard: -inoperable because of vascular disease (medically inoperable) and because of poor lung function (FEV1 1.4 l) -radical RT alone without ChT because of vascular disease and age Prescription of dose and RT planning: 32 x 2 Gy = 64Gy in 1 series Target-Volume: do a PET (mediastinal LN, atelectasis): no LN, no atelectasis GTV:

  9. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage: T2 Nx M0 Tumorboard: -inoperable because of vascular disease (medically inoperable) and because of poor lung function (FEV1 1.4 l) -radical RT alone without ChT because of vascular disease and age Prescription of dose and RT planning: 32 x 2 Gy = 64Gy in 1 series Target-Volume: do a PET (mediastinal LN, atelectasis): no LN, no atelectasis GTV: Gated CT: GTVinsp + GTVexsp CTV:

  10. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage: T2 Nx M0 Tumorboard: -inoperable because of vascular disease (medically inoperable) and because of poor lung function (FEV1 1.4 l) -radical RT alone without ChT because of vascular disease and age Prescription of dose and RT planning: 32 x 2 Gy = 64Gy in 1 series Target-Volume: do a PET (mediastinal LN, atelectasis): no LN, no atelectasis GTV: Gated CT: GTVinsp + GTVexsp CTV: GTV + 0.8cm PTV:

  11. A. A., male ,71y History: -Stenosis A. carotis interna, preoperative routine workup, pulmonal finding -CT: tumor right upper lobe, 3cm, mediastinal LN max. 1cm -Cytology: no malignant cells -FNP: NSCLC large cell G3 Stage: T2 Nx M0 Tumorboard: -inoperable because of vascular disease (medically inoperable) and because of poor lung function (FEV1 1.4 l) -radical RT alone without ChT because of vascular disease and age Prescription of dose and RT planning: 32 x 2 Gy = 64Gy in 1 series Target-Volume: do a PET (mediastinal LN, atelectasis): no LN, no atelectasis GTV: Gated CT: GTVinsp + GTVexsp CTV: GTV + 0.8cm PTV: CTV + (0.5) - 1cm (all directions)

  12. A. A., male ,71y 2 field plan: 1800 6.8 x 7.0cm 2600 6.6 x 7.1cm GTV: Gated CT: GTVinsp + GTVexsp CTV: GTV + 0.8cm PTV: CTV + (0.5) - 1cm (all directions)

  13. K. E., male ,78y History: -inpatient because of pain left chest wall -CT: large tumor (max. 9cm) with contact to pleura and chest wall and mediastinum, no mediastinal LN

  14. K. E., male ,78y History: -inpatient because of pain left chest wall -CT: large tumor (max. 9cm) with contact to pleura and chest wall and mediastinum, no mediastinal LN -Transthoracal biopsy: Adenocarcinoma G3 Stage:

  15. K. E., male ,78y History: -inpatient because of pain left chest wall -CT: large tumor (max. 9cm) with contact to pleura and chest wall and mediastinum, no mediastinal LN -Transthoracal biopsy: Adenocarcinoma G3 Stage: T3-4 N0 Mx G3 Tumorboard:

  16. K. E., male ,78y History: -inpatient because of pain left chest wall -CT: large tumor (max. 9cm) with contact to pleura and chest wall and mediastinum, no mediastinal LN -Transthoracal biopsy: Adenocarcinoma G3 Stage: T3-4 N0 Mx G3 Tumorboard: -not primary operable, not medically operable (cardiac disease, diabetes, age..) -local radical radiotherapy (no cc ChT because of age) Prescription of dose and RT planning: Dose / Fx:

  17. K. E., male ,78y History: -inpatient because of pain left chest wall -CT: large tumor (max. 9cm) with contact to pleura and chest wall and mediastinum, no mediastinal LN -Transthoracal biopsy: Adenocarcinoma G3 Stage: T3-4 N0 Mx G3 Tumorboard: -not primary operable, not medically operable (cardiac disease, diabetes, age..) -local radical radiotherapy (no cc ChT because of age) Prescription of dose and RT planning: Dose / Fx: 13 x 3Gy = 39Gy Volume:

  18. K. E., male ,78y History: -inpatient because of pain left chest wall -CT: large tumor (max. 9cm) with contact to pleura and chest wall and mediastinum, no mediastinal LN -Transthoracal biopsy: Adenocarcinoma G3 Stage: T3-4 N0 Mx G3 Tumorboard: -not primary operable, not medically operable (cardiac disease, diabetes, age..) -local radical radiotherapy (no cc ChT because of age) Prescription of dose and RT planning: Dose / Fx: 13 x 3Gy = 39Gy Volume: Primary (without mediastium) / how to identify the primary ? (large tumor ! / atelectasis ?)

  19. K. E., male ,78y History: -inpatient because of pain left chest wall -CT: large tumor (max. 9cm) with contact to pleura and chest wall and mediastinum, no mediastinal LN -Transthoracal biopsy: Adenocarcinoma G3 Stage: T3-4 N0 Mx G3 Tumorboard: -not primary operable, not medically operable (cardiac disease, diabetes, age..) -local radical radiotherapy (no cc ChT because of age) Prescription of dose and RT planning: Dose / Fx: 13 x 3Gy = 39Gy Volume: Primary (without mediastium) / how to identify the primary ? (large tumor ! / atelectasis ?) Possible solutions: PET-CT fusion 3-4 x 3Gy then new planning CT (atelectasis may disappear)

  20. K. E., male ,78y Prescription of dose and RT planning: Dose / Fx: 13 x 3Gy = 39Gy Volume: Primary (without mediastium) / how to identify the primary ? (large tumor ! / atelectasis ?) Possible solutions: PET-CT fusion 3-4 x 3Gy then new planning CT (atelectasis may disappear)

  21. K. E., male ,78y History: -inpatient because of pain left chest wall -CT: large tumor (max. 9cm) with contact to pleura and chest wall and mediastinum, no mediastinal LN -Transthoracal biopsy: Adenocarcinoma G3 Stage: T3-4 N0 Mx G3 Tumorboard: -not primary operable, not medically operable (cardiac disease, diabetes, age..) -local radical radiotherapy (no cc ChT because of age) Prescription of dose and RT planning: Dose / Fx: 13 x 3Gy = 39Gy Volume: Primary (without mediastium) / how to identify the primary ? (large tumor ! / atelectasis ?) Possible solutions: PET-CT fusion 3-4 x 3Gy then new planning CT (atelectasis may disappear) GTV: visible tumor on CT CTV: GTV + 0.8cm PTV: CTV + 1cm / 1.5cm cc 2 field plan: 00 13.7 x 13.8cm 1800 14.1 x 13.5cm

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