Thoracic

Lung cancer, particularly non–small-cell lung cancer (NSCLC), remains the leading cause of cancer-related mortality. For inoperable patients, radiation therapy provides an effective, non-invasive alternative. This chapter discusses the unique challenges of thoracic radiotherapy, including the complexities of treating targets within the thoracic region which are significantly affected by respiratory motion. The chapter begins by discussing prescription and treatment intent for thoracic sites, outlining common fractionation schemes based on clinical goals. Special considerations – such as the presence of implanted devices – are reviewed, along with techniques for minimizing dose to these devices. Simulation is discussed in detail, with specific emphasis on motion management strategies and quality checks to minimize issues arising at the planning or treatment stages. The chapter also presents best practices for thoracic treatment planning, including appropriate beam energies, delivery techniques, and organ-at-risk constraints. This chapter aims to provide a comprehensive overview of thoracic radiotherapy, while emphasizing individualized treatment planning, downstream strategies for optimizing plan quality, and ultimately, better patient outcomes.