Figure 2.

Dose distribution for a representative patient with a 6.6 cm T4N2M0 stage IIIB right upper lobe adenocarcinoma treated with contralateral lung and esophageal sparing IMRT technique. The patient was treated with carboplatin, paclitaxel, and thoracic RT to 73 Gy via four-field IMRT. The patient developed acute grade 2 dysphagia, grade 1 dermatitis, and right upper arm deep vein thrombosis. The patient remains alive and free of progression or late toxicity at 21 months. (A) Axial dose distribution demonstrates relatively poor conformality but excellent sparing of the esophagus and contralateral lung. (B) Coronal isodose distribution. (C) Dose–volume histogram demonstrates excellent coverage of the dominant mass (PTV70) and targeted lymph nodes (PTV63) with selective sparing of esophagus and lung.