Do you contour the brachial plexus when treating chestwall and SCV?

[lazers]

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Do you contour the brachial plexus when treating chestwall and SCV?

Treating chest wall to 50 Gy plus a scar boost?

 

[Gfunk6]

At those dose levels, I do not contour. However once point doses in the soft tissues reach or exceed 60 Gy, I contour. This is typically only the case in H&N and lung.

 

[medgator]

At those dose levels, I do not contour. However once point doses in the soft tissues reach or exceed 60 Gy, I contour. This is typically only the case in H&N and lung.

I do the same. I've seen tolerances of 60-66 Gy mentioned. RTOG 0617 used 66 Gy as a tolerance for treating Stage IIIA lung CA. That's where I start to get worried and contour. Some old school folks will tell you it's probably a non-issue in H&N even at 70 Gy considering the techniques used back then.

Part of the nuance is also what site you are treating. I think I would pretty strict with breast, H&N and non-pancoast lung. Things are more complicated with an apical/pancoast lung with nerve involvement (http://www.redjournal.org/article/S0360-3016(12)00448-8/abstract)

 

[Neuronix]

At those dose levels, I do not contour. However once point doses in the soft tissues reach or exceed 60 Gy, I contour. This is typically only the case in H&N and lung.

Agreed. For dose tolerance of the brachial plexus I like to refer to:

http://www.ncbi.nlm.nih.gov/pubmed/22658442
http://www.ncbi.nlm.nih.gov/pubmed/22284035

I am a member of the controversial camp that the brachial plexus can take more dose than we give it credit for (up to the doses in those papers above). I think some of our constraints are too low based on older data before modern treatment planning and QA, when we had hot spots or delivery errors >15% that we didn't even know about.