Do you base liver SBRT dose fractionation on size, volume, or proximity of normal tissue?
For example, would you use a cutoff such as PTV of 25cc, or 4cm diameter, or simply use nearby normal tissue constraints to alter your fractionation from 20Gy x 3 fractions to a more fractionated course?
Answer from: Radiation Oncologist at Academic Institution
I think about this differently than most people do. My goal is to deliver an ablative dose (100Gy BED) regardless of the proximity of organs at risk or the size of the tumor. The more common thing to do is to reduce the dose of radiation below an ablative dose to 40 or 30Gy in 5 fractions. I'm not s...
Answer from: Radiation Oncologist at Academic Institution
@Christopher H. Crane's paper (JCO 2016 34:3, 219-226) is a very good report on IHC, and given the fact that few other institutions can accumulate such a sizeable experience, I think it is hard to argue with their nuanced approach in that setting. Their discussion acknowledges all of the caveats inh...
Answer from: Radiation Oncologist at Academic Institution
The stricture risk with 3-5 fraction SBRT is still probably an open question for small nonbiliary tract cancers. It is a resistant structure, but the consequences can be high, anywhere from lifelong dependence on stent exchanges, to cholangitis or even death if a stricture develops. I have seen anec...
Comments
Radiation Oncologist at Mallory Radiotherapy, PLLC Do you have any concerns about using the 75/25 fra...
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