Stereotactic Body Radiotherapy   

Do you use the same regimen for primary treatment, re-treatment, and post-op?

Specifically in O2-dependent patients? Have any dose/fractionation regimens been shown to reduce the risk of pneumonitis in this population?

What is your volume and point dose constraint within the vertebrae itself when prescribed 1 fx, 3 fx,  5 fx SBRT spine to reduce incidence of ver...

When is SBRT appropriate? Do you approach dose and fractionation differently in this setting?

If so, what dose/volume is prescribed? How do you account for motion?

If so, what dose?

What is the risk of renal artery stenosis causing malignant hypertension and at what dose does this become an issue?

The patient is not pacemaker dependent. 

In other words, if offered wedge or segmentectomy, should SBRT be preferred? Does size matter ie if the lesion is < 3 vs < 2 vs < 1 cm? Does ...

For example, consider a patient who has had previous hepatectomy and total liver volume is only slightly greater than 700 cc.

Do you factor in the time interval when deciding cumulative dose constraints?

Does fractionation (or location) influence this decision? What is your preferred steroid dose?

Is it possible to do SBRT?

I see the LungTECH trial dose constraints, but, they seem really conservative when you have something large and close the PBT resulting in use of 60 G...

How would you approach treatment if SBRT was not technically possible? How would you opt to treat if SBRT was instead not covered by insurance, and w...

What fractionation scheme would you use?  Would you give SBRT to a hilar tumor that has N1 nodal involvement adjacent to the tumor but can be enc...

How does your approach change for same lung but now a different lobe v. different lung? How do you adjust your constraints?

For example, would you modify your SBRT dose next to the azygous vein? While we talk frequently about OAR constraints for the great vessels, it seems ...

What dose would you recommend? Is SBRT needed? 

Would you offer SBRT over standard fractionation of smaller tumors?

In treating an oligometastatic lesion in the sacrum, is it reasonable to extrapolate from RTOG brachial plexus contraints (eg, 8 Gy/fx for a 3-fractio...

Is the dose fractionation used in BR-001 (10Gyx3) appropriate for all osseous locations, for example humeral head metastases?

If so what is the crietria?

Would close proximity to the heart/aorta affect your dose and fractionation?

Are pre-treatment PFTs actually correlated with treatment-related toxicity? If no absolute cutoff, do you have an ideal lower limit for PFTs...

Would you consider SBRT and if so what dose/fractionation would you use if the lesion was in the head of the mandibula? If not would you give a fract...

For that occasional "single lymph node metastasis" referral in patients with no other sites of disease, is there a therapeutic dose below which you're...

Does tumor location play a role (central vs peripheral) in making the decision?  The question stems from an oral presentation at ASTRO 2014 inves...

Would you alter your SBRT dose? How long would you hold the VEGF inhibitor before and after? Does the primary matter (e.g. NSCLC vs. colorectal)?

Would this location be adequate for SABR, if so what dose scheduling would be recommended?

For example in a patient with a good performance status and a biologically favorable cancer (ER+ breast cancer, EGFR+ NSCLC, or prostate cancer), are ...

Is there a benefit to one fractionation schedule v. the other?

I am treating a left lower lobe NSCLC and my PTV is so close to the spleen that a small portion of the spleen is getting significant dose.  I can...

And at what intervals?

Would you consider treating 3-5mm lesions with SBRT or wait until they are a certain size? I am concerned I will not be able to see them adequately on...

There seem to be a lot of different fractionation schemes in the literature. Is there one that is most standard?

Do you prefer breath-hold techniques (ABC, DIBH) or abdominal compression regardless of tumor motion? Or do you use a general threshold number of cc's...

The Indiana report and RTOG published a "danger zone".  There was a catastrophic "case report" for 50 Gy in 5 fractions.  Are there alternat...

Is there a dose response relationship, as suggested in the phase I MSKCC dose escalation study presented at ASTRO 2017?

In a patient with a cavitated lesion with underlying chronic infection (identified as cocci) and SqCC, are there additional risks to SBRT? Should spec...

In patients with aberrant anatomy due to previous surgery with lung PTV overlapping the stomach, how much would you dose de-escalate? Even conventiona...

What dose and fractionation would you consider if surgery is not an option? 

Do you discuss this at the first consultation? Is there strong evidence to suggest that risks are significantly increased compared to upfront lobectom...

Is local control worse for SBRT when the tumor is invading into the bone (rib)?

Aside from steroids and PT, is there anecdotal evidence for warfarin, hyperbaric oxygen, bevacizumab etc. Any experience with these therapies?

For example, a NSCLC of the LLL abutting and potentially involving the adventitia of the descending aorta?

In a patient with pain that does not respond well to narcotics what would be your treatment approach?  Is there any data that suggests patients c...

If so, 50 Gy / 5 fx? 7.5 Gy / 8 fx? If so what dose constraints would you use to help determine fractionation?

Is there a role for SBRT to the primary site? Is it required to treat the ipsilateral hilum if no adenopathy was seen on EBUS or PET?

Given the multiple retrospective studies showing benefit to higher BED fractionation schedules (most recently, http://www.redjournal.org/article/S0360...

Is another course of SBRT possible? If so, what are the important planning considerations?

Given the lepidic growth pattern, do you use similar margins as with frankly invasive lung tumors? Are there any challenges localizing the target with...

When treating lung tumors abutting the visceral pleura/chest wall with SBRT, chest wall or rib pain sometimes occurs. In these cases, I try to avoid i...

If given options of liver, lung, spine, brain, axilla, or other lymph nodes which sites do you pick?

If so, how would you approach treatment?

Any special dosing considerations or can you approach this like any other small peripheral NSCLC?

Which imaging studies do you perform and what is the timing after treatment?

Does your volume change based on fractionation (high-dose single fraction vs. 3-5 fractions)? Do you treat the entire circumference of long bones? Wha...

Are there specific conformality parameters you prioritize (105% dose volume outside of PTV, conformality index, ratio of 50% isodose volume to PTV, an...

Recently, while planning a patient for lung SBRT it was suggested by the physicist that we change the density of the PTV to higher density to improve ...

Have you ever seen toxicity related to diaphragm dose with conventional fractionation?  

And at what intervals? The published trials/RTOG call for q3 month MRI follow-up. Is this appropriate outside a clinical trial setting? 

If surgical stabilization has been performed, do you go with SBRT dosing? If so, do you treat only the involved site and not the extent of hardware? D...

What is the average healing time? What medications and/or procedures do you recommend for pain control? Does management differ for those with chest wa...

Do you specify an isodose line to prescribe to? Do you ask for a percent hot, and if so do you specify what percent or volume of the GTV/ITV should re...

Under what clinical circumstances would you consider prescribing them?

For example, in a patient minimal brain and liver metastasis, would you treat all sites definitively?

If a biopsy carries a high risk of morbidity what interventions would you recommend for the local failure?

In my training, we used an abdominal compression paddle, but in my current practice, my physicist says that we cannot treat through multiple parts of ...

As it is suggested for larger tumors treated with surgery, based on post hoc CALGB analysis?

If so, how? Or would you avoid SBRT in such a situation? 

In starting prostate SBRT at an instutution, what are issues with the treatment that one should pay special attention to?

Will the NCCN guidelines change based on this study?

What are the targets (tumor bed, positive margin, nodes etc.)?

If so what dose-fractionation do you use and what constraints for brachial plexus?

Specifically from a GI primary?

The BED10 for 50 Gy in 5 fractions is 100, which is significantly lower then the BED of the 54 Gy in 3 fractions regimen (151). Since the Kestin/Grill...

Our dosimetrists rarely meet the RTOG constraint using a non-coplanar technique, especially for very small lesions. I haven't been able to find a corr...

What factors should be considered with offering SBRT to oligometastatic bone disease in prostate cancer patients? Should this been done off of a proto...

Any advice on how to safely incorporate it into our practice?

Would you consider placing a stent in this patent graft to minimize closure of the graft after SBRT?

Is there any concern about hemorrhage from treatment effect on tumor? Would SABR worsen the chance of fatal hemorrhage/hemoptysis and if so, would you...

For small overall volumes (e.g. 0.5cm solid component, 1cm total lesion size when including GGO), I imagine treating the entirety of the abnormality i...

Roughly what percentage of patients are treated without a biopsy?

ASTRO 2014's lung session presented data from RTOG 0236, showing a 20% intralobar failure/recurrence despite only 7% local failure. How does one recon...

RTOG 0915 allows either technique, but I've heard people say that IMRT is not "technically" SBRT. Is there is a benefit to the non-coplanar 3D techniq...

Should fractionated EBRT be administered or can repeat SBRT be used?

In SBRT, it has been said that Pencil Beam dose calculation algorithm can overestimate the target dose and understimate the normal tiss...

What dose/fractionation is appropriate and does it differ between histology?

What are the primary data that drove organ at risk and conformality dose constraints?