if there was a different paper I may have missed it. the one im aware of is this:
they used 5 mm PTV straight off GTV in the 0 mm CTV arm.
they used 5 mm PTV straight off GTV in the 0 mm CTV arm.
I would argue that we all know there is never going to be a randomized trial for something like lung CTV. It would need to be massive to do a non inferiority study, and that is not practical or rational for this minor a question.
Instead ask yourself what randomized evidence we have to support using a CTV in the lung? Why does potential microscopic disease need 60 gy anyways? How many times have you had an isolated failure in the putative CTV? Our PTVs themselves are already covering theoretical adjacent microscopic disease to full dose. Why don’t we use CTVs in stage 1 SBRT?
All of that plus some data makes me comfortable starting to think about dropping it, but I totally get why others wouldn’t, I just don’t know that we will get much more large scale randomized data or evidence. Hopefully people publish their experiences for those like Drew doing it standardly.
to me it almost seems too Rad-Oncy to be so conservative with something like this.
Where we got the radiographic diagnosis of “square pneumonia” from!
it’s totally fine to make the argument that you don’t need a ctv if you contour every last white bit on the lung window 4d max projection then add a single large expansion but then don’t patronize someone who essentially does for all intents and purposes the same thing. Clearly I suck at memes if I have to spell this out.The simple argument is that we don’t need CTV in the lung, which I agree with. Your mileage may vary. Not everything needs to be so deep, controversial, or past trauma inducing here.
What perhaps needs to be challenged is the whole ICRU-50 concept.it’s totally fine to make the argument that you don’t need a ctv if you contour every last white bit on the lung window 4d max projection then add a single large expansion but then don’t patronize someone who essentially does for all intents and purposes the same thing. Clearly I suck at memes if I have to spell this out.