Lung SBRT

Conformal vs
VMAT
Haylee Cross & Mark McGee
 My Patient
● 45-year-old caucasian male

● Stage IV testicular mixed germ cell

○ (50% seminoma, 40% embryonal
rhabdomyosarcoma, 10% teratoma)

● Metastatic disease to LUL

○ Lung nodule treated with SBRT
 SBRT Immobilization
Immobilization for lung SBRT:
● Civco board
● Wing board
● Red knee sponge
● Clam-lok cushion
● Respiratory plate

Why do we use special

immobilization for SBRT?
● Decrease tumor motion
● Allow for smaller margins
● Increase precision of
treatment delivery
 Why do a 4DCT?

Motion Setup
It helps the dosimetrists To evaluate the type of
visualize the ITV and make motion management
proper margins/contours (gating, compression)
Planning Objectives
01

SBRT
Why is my patient a candidate
for SBRT?
● Small GTV
● Centrally located more than 2 cm from the main bronicholes and great
vessels
 02
VMAT
Plan
 VMAT

● 2 L-sided half arcs

● 6 FFF
● More weighting for the
first, clockwise arc
VMAT

● PTV max: 127.3%

● PTV min: 83.6%
● Notice anything concerning
with this plan?
 03
3D
Confor
mal
 3D
Confor
● 2 L-sided dynamic conformal arcs
● Equal beam weighting

mal
 3D
Confor
mal
Which one do you think is conformal and which is VMAT?
squares= VMAT, triangles= 3D conf
MLC
VMAT 3D conformal
SBRT!
Which plan would you chose?
 3D Conformal
- It was decided that my patient would treated 3D conformal
- For lung treatments, simpler usually = better
- Interplay effect
- Major downfall of VMAT is the MLC movement
- The MLCs may cover the PTV at an inopportune time, as you could see in the video

5400 cGy, 1800 cGy per fx, 3 fx

PTV= ITV + 5 mm of margin

 The
05 End