International journal of radiation oncology, biology, physics 2022 Jan 01
A Story of Hypofractionation and the Table on the Wall.
Related Questions
How do you contour the cauda equina for a lumbar spine SBRT case below the spinal cord?
I typically contour the cauda equina at the level of the upper lumbar spine just below the spinal cord based on T2-weighted MRI and utilize a 2 mm PRV. If the entire spinal canal is instead contoured just below the cord, this may lead to underdosing of the posterior aspect of the vertebral body.At t...
What dose constraints do you use for RCC/Kidney SBRT?
As is often the case, there is no single answer to this question, and the ALARA principle should always be kept in mind. A good starting place to determine your OAR constraints for a given case is to consider the clinical context. Ultimately, in deciding on allowable OAR constraints, one has to cons...
What is your approach for LINAC based radiosurgery when dealing with benign perioptic lesions very close to the optics apparatus?
It all starts with the consideration of what I consider an effective dose of SRS or SRT (hypo-fractionated SRS). The minimum effective dose to achieve local control of a metastatic lesion is usually 18 Gy for single fraction, 27 Gy for 3 fractions, and 30 Gy in 5 fractions.I then consider the histol...
How do you manage an intramedullary benign nerve sheath tumor post sub-total resection seen on post-operative MRI?
Intracranial schwannomas respond well to low dose SRS (11.5-12 Gy) or SRT (25 Gy in 5 fractions) Slane et al., PMID 28089525 However, both of these approaches use a somewhat higher dose than the spinal cord tolerance doses. Therefore, I would treat the patient on a radiation delivery system equippe...
What dose fractionation would you utilize for a large solitary liver metastases about 7 cm, abutting colon?
Given that this is a solitary metastasis, I would favor surgery for this patient if adequate healthy liver volume can be spared and there are no other contraindications. This will offer the best outcome. If this patient is not resectable then the best regimen to treat this metastasis depends on how ...