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Radiation Oncology • Thoracic Malignancies
Is it safe to offer SBRT for a secondary NSCLC after breast or chest wall irradiation many years prior?
Do you worry about chest wall necrosis? Is surgery preferable? Does the previous RT affect your dose and fractionation? I am seeing more patients with early stage NSCLC in the previous breast/chest wall field 15-30 years after prior RT.
Answer from: Radiation Oncologist at Academic Institution
I agree with @Alexander V. Louie. Surgery is preferred here. However, if surgery is not an option or is high risk, I would offer SBRT. I still offer 10 Gy x 5 in this setting because if I do it, I still want to offer the best chance for tumor control (10 Gy x 5 has a BED10 = 100 Gy, the threshold do...
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Answer from: Radiation Oncologist at Academic Institution
Generally speaking, it is safe to offer SBRT for a second primary lung cancer, after initial radical management of a lung or breast cancer that has been treated with primary radiotherapy. In fact, some series have reported repeat lung SBRT in areas of local recurrence, with decent results.Of course,...
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Radiation Oncologist at UCLA
Thank you so much for this answer! How might you t...
Thank you so much for this answer! How might you t...
Answer from: Radiation Oncologist at Academic Institution
Most of time, it is reasonably safe to deliver SBRT after prior RT to chest wall many years ago. If the lesion is large (>3 cm) and very close to the chest wall (< 5 mm), we would consider 70 Gy in 10 fractions instead of 50 Gy in 4 fractions. With control of the chest wall dose volume constra...
Answer from: Radiation Oncologist at Community Practice
It depends. You can use longer fractionations like 5-7 fractions.