What dose/fractionation scheme would you use for a bulky (>15 cm) metastatic renal cell carcinoma deposit with brachial plexus encasement and spinal canal invasion?   

This is a remarkably complex clinical scenario where standard approaches are not likely to achieve the palliative response desired. Therefore, we would approach this challenging clinical situation with highly tailored and compact as possible SBRT-like fields using a dose fractionation of 800 cGy per...

For bulky tumors over 10 cm in need of high-dose palliation for definitive local control, I use GRID in combination with EBRT. Usually, we start with 1 cm open holes in the MLC, with 75% of the area closed, typically a 10 MV beam, single field. 15 Gray x1 fraction to Dmax, a few days break, then the...