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All known gross diseases were treated to 54 Gy.
The primary and nodal gross tumor volumes (GTV-P and GTV-N) included all gross diseases visualized on CT and/or MRI.
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The initial sites of gross disease, including the anterior mediastinal node was included in the CTV for PMRT, and treatment planning demonstrated a clear advantage to the inclusion of proton fields in this case.
It has been reported that even in the Cynomologus macaque model, which is the representative animal model depicting human TB, the amount of gross disease seen at 60 days post-infection could not predict the establishment of latent disease [22].
GTV consisted of gross disease noted on the MRI and physical exam.
For the reduced field, a 2 cm margin was given to the site of gross disease.
Prior to SBRT, 7 patients had gross disease present visible on MRI or physical exam.
After cone-down, the gross disease was treated all the way.
The CTV was reduced after 45 Gy to include gross disease with a 1-cm margin.
The final 5.4 Gy was given to a boost field encompassing any gross disease with a 2 cm margin.
The rationale of CRS plus HIPEC is based respectively on the removal of gross disease and on the eradication of microscopic residual disease.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com