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Is there a firm rib dose constraint when treating lung tumors abutting the visceral pleura/chest wall with SBRT?
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 including the entire rib thickness in the expanded treatment volume. Any other recommendations?
Answer from: Radiation Oncologist at Academic Institution
While I am concerned about chestwall pain and rib fractures, I am usually reluctant to alter my volume or dose. At the Radium Society Meeting in 2013, Ben Slotman released data on local recurrences after SBRT, and he found a 3 year recurrence rate of ~8%. More interestingly, he found that 56% of the...
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Answer from: Radiation Oncologist at Academic Institution
I agree with Thomas. When Brian Kavanagh, Tracey Schefter and I originally published the dose volume constraint for chest wall, we found that 30cc receiving 30Gy was most correlative with chest wall toxicity. I think what people commonly do is use this as a hard constraint and compromise coverage....