Radiation Oncology Treatment Plans by Cancer Stage

Non-Small Cell Lung Cancer (NSCLC)

The European Society for Medical Oncology recommends stereotactic body radiation therapy (SBRT) as the primary treatment for medically inoperable patients or those refusing surgery, delivering 6-18 Gy per fraction over 2-8 sessions 1
Intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) is preferred over 3D conformal techniques for NSCLC treatment 1
Selective nodal irradiation (only proven or highly suspicious nodes) is recommended over elective nodal irradiation for NSCLC patients 1
Concurrent chemoradiotherapy with 60 Gy in 30 fractions (2 Gy daily) remains the standard of care for locally advanced NSCLC, based on RTOG 0617 which demonstrated superior outcomes compared to dose escalation 2
The American Society of Clinical Oncology recommends that doses above 60 Gy up to 70 Gy may be considered in well-selected NSCLC patients with strict normal tissue constraints, but doses above 70 Gy should not be used outside clinical trials 2

Prophylactic cranial irradiation should be offered after response to chemotherapy for SCLC patients 1
Consolidation thoracic radiation therapy after partial or complete response to systemic therapy, especially with low burden of extrathoracic disease, is recommended for extensive stage SCLC patients 1

The National Comprehensive Cancer Network recommends primary surgery with Piver II or III hysterectomy plus pelvic lymphadenectomy as the standard treatment for microinvasive cervical cancer, with radiotherapy reserved for adverse features 3
Lymphadenectomy must include external iliac nodes at minimum for cervical cancer patients 4
Ovarian transposition with radio-opaque markers is recommended if ovaries are conserved for cervical cancer patients 4
Concurrent radiochemotherapy incorporating cisplatin is the standard treatment for poor prognosis cervical cancer, demonstrating significant improvement in local control and overall survival 3, 5

The American Society of Clinical Oncology recommends whole-breast radiation therapy delivering 4,500-5,000 cGy at 180-200 cGy per fraction using opposed tangential fields, typically beginning 2-4 weeks after surgery for breast-conserving surgery patients 7, 8
Higher energy photons (≥10 MV) are indicated for large-breasted women or significant dose inhomogeneity for breast cancer patients 7
Lung constraints, such as maximum 3-3.5 cm of lung in treatment field, should be observed to minimize pneumonitis risk for breast cancer patients 7
Cardiac constraints, such as minimizing heart exposure for left-sided lesions, should be observed for breast cancer patients 7
The European Society for Medical Oncology recommends boost irradiation to the primary site for breast cancer patients after breast-conserving surgery, with a total dose of approximately 6,000-6,600 cGy 9

Three-dimensional conformal techniques or IMRT with dose homogeneity verification should be used for treatment planning 1, 2
Normal tissue constraints must be strictly observed to balance tumor control with toxicity 2
Total treatment time matters, and prolonged duration negatively impacts local control, particularly in cervical cancer 6
Concurrent chemotherapy enhances radiation effectiveness but increases toxicity requiring careful monitoring 2, 3, 5