**9. Radiotherapy dose and fractionation**

#### **9.1. Radical treatment**

#### *9.1.1. Early stage T1-3N0 disease and fit patients: use SBRT*

‐ For peripherally located tumor: 54 Gy in three fractions or 60 Gy in five fractions, alternate day treatment over 1–2 weeks (more conservative schedule is recommended if PTV is in contact with chest wall to avoid rib toxicities).


*9.1.3. Locally advanced stage III disease: use conventional radiotherapy*


#### **9.2. Adjuvant treatment**

Radiotherapy plans should be carefully evaluated using dose‐volume histogram (DVH). Optimal plan should aim at 95% PTV receiving at least 100% of the prescribed dose and 99% PTV receiving a minimum of 90% of the prescribed dose. For OARs, commonly used dose constrains for lung minus PTV is V20 (volume receiving >20 Gy) below 35%, preferably below 30%. However, a tighter constrain to reduce the risk of radiation pneumonitis should be con‐ sidered when there is presence of other risk factors including preexiting lung disease and concurrent use of chemotherapy. Another frequently used limit is the mean lung dose below 20 Gy. The dose constrains for other OARs are maximum dose to spinal cord less than 45 Gy and heart V20 less than 40 Gy. Care should be given to avoid irradiation of more than 10 cm

For SBRT, either intensity‐modulated radiotherapy using 6–8 fields (IMRT) or rapidarc ther‐ apy is recommended to deliver a high and conformal dose to a precise area (**Figure 15**). Dose to skin should be minimized to avoid cutaneous and subcutaneous toxicities. Recommendations to other OARs can be made reference to that published by ROSEL study and RTOG 0813 study.

‐ For peripherally located tumor: 54 Gy in three fractions or 60 Gy in five fractions, alternate day treatment over 1–2 weeks (more conservative schedule is recommended if PTV is in

**Figure 15.** Beam arrangement and dose color wash from SBRT for lung cancer using IMRT technique.

length of the esophagus due to higher long‐term risk of stricture.

**9. Radiotherapy dose and fractionation**

*9.1.1. Early stage T1-3N0 disease and fit patients: use SBRT*

contact with chest wall to avoid rib toxicities).

**9.1. Radical treatment**

40 Radiotherapy


#### **9.3. Palliative treatment**

