Lung corrections in photon beam treatment planning: are we ready?

This paper reviews reasons cited for and against the use of lung corrections. It is suggested that all the reasons cited for not making corrections are no longer viable. A phantom has been designed to simulate the thorax region of a patient at both CT and radiotherapy radiation energies. With this phantom, lung correction factors for the calculation of tumor dose have been measured for a typical lung cancer treatment regimen, and these results are shown to compare favorably with correction factors computed by all the commonly employed correction algorithms. Some algorithms are better than others, and one of the best is the readily hand-calculable generalized power-law TAR method. It is shown that failure to correct for lung transmission can severely limit the integrity of many interinstitutional studies, especially cooperative clinical trials. It is concluded that lung corrections for the calculation of tumor doses in the thorax region should be gradually introduced over the next several years.