Do you use a chest wall constraint when treating large lung cancers with 8 or 10 fraction SBRT?  

There are a few studies that report that the volume receiving 30 Gy correlates to toxicity, and the Kavanaugh paper provides a "rule of thumb" - if 30cc of chest wall receives 30 Gy or more, then there is a 30% risk of severe chest wall toxicity. Dr. Videtic at Cleveland Clinic reports this, as well...

Obviously, hypofractionated therapy for lung cancer is become more common in both early stage disease or larger tumors not amenable to chemoRT or surgery. The primary issue is how do you best balance tumor control and toxicity. As oncologists, our primary concern is usually controlling the cancer ...

The occurrence of rib fractures and chest wall pain following SBRT is becoming better recognized, with the publication of at least 2 relatively large retrospective series which have attempted to define a dose-volume relationship, suggesting that when 35 ml or greater chest wall volume receives 30 Gy...