1. 4-Dimensional Treatment Planning of Lung Tumors

2. Lung Cancer 1 out of 14 people will be diagnosed with lung cancer at some point in their life! 90% of lung cancer is caused by SMOKING.

3. 5 years after diagnosis, only 16% survive!

4. Treatment Options Surgery Chemotherapy Radiation Therapy – Photons – Protons

5. Photons v. Protons

7. Chen, Mori, SharpWIP Brown Bag March 3, 2009 More distal lung is irradiated 1 Accumulated doseDeformed doseOriginal Room viewOrgan view Voxel view

8. LungEUD1 Analysis GTY Chen Ashley Rubenstein et al September 28, 2010

9. EUD1 Fovia

11. Ant Field GIF no distal margin

12. Post Field GIF

13. Observations With post field, there is range perturbation distal to target during motion More normal lung is irradiated Distal lung density is altered; so deeper geometric penetration. Therefore EUD could change in 4D planning vs 3D planning. Magnitude depend on degree of motion and compensator design.

14. EUD2 Analysis GTYC / AER September 28, 2010

17. LPO single field dose Gif

18. Post Obliques 2F plan GIF

19. EUD3 Analysis Sept 28 2010

23. Single field dose distribution

26. Plan 4 field plan Quite robust to motion! Use more fields in proton lung!