Radiotherapeutic Management of Non–Small Cell Lung Cancer in the Minimal Resource Setting Danielle Rodin, MD, Surbhi Grover, MD, MPH, Melody J. Xu, MD,

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Radiotherapeutic Management of Non–Small Cell Lung Cancer in the Minimal Resource Setting Danielle Rodin, MD, Surbhi Grover, MD, MPH, Melody J. Xu, MD, Timothy P. Hanna, MD, MSc, Robert Olson, MD, MSc, L. John Schreiner, PhD, Anusheel Munshi, MD, DNB, MNAMS, Francoise Mornex, MD, PhD, David Palma, MD, PhD, Laurie E. Gaspar, MD, MBA Journal of Thoracic Oncology Volume 11, Issue 1, Pages 21-29 (January 2016) DOI: 10.1016/j.jtho.2015.09.008 Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 (A) An illustration of the concept of two-dimensional treatment planning. The field borders (blue line) encompass the upper mediastinum and neck and would be placed using anatomy visible on radiographs or fluoroscopy. The patient would be treated with opposing anterior and posterior beams. (B) An electronic portal image showing a patient at the time of treatment, with the field borders (blue) superimposed. Journal of Thoracic Oncology 2016 11, 21-29DOI: (10.1016/j.jtho.2015.09.008) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 Blocks used for beam shaping. These hand-poured metal blocks are placed into the treatment machine to attenuate the beam in selected areas. Journal of Thoracic Oncology 2016 11, 21-29DOI: (10.1016/j.jtho.2015.09.008) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 3 Radiation treatment planning and delivery for stage III non–small cell lung cancer. Normal tissues and tumor target volumes are outlined on a planning computed tomography (CT) scan (Panel A, axial; Panel B, coronal). The tumor and involved nodes are outlined (blue), and margins added for microscopic extension (green) and setup error produce the planning target volume (red color wash). The prescription dose is 60 Gy in 30 fractions, and the 95% dose line (thick yellow) and 50% dose line (thin white) are shown. Normal structures are also outlined (left lung, esophagus, heart, and spinal cord are shown). For treatment delivery, a cone beam computed tomographic image (Panel C, inset) is acquired aligned to the planning computed tomographic image (Panel C, main image) to confirm positioning. Journal of Thoracic Oncology 2016 11, 21-29DOI: (10.1016/j.jtho.2015.09.008) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions