When do you offer SBRT for a small, slowly growing lung lesion?

I caution ALL radiation oncologists from pulling the trigger on a case like this in a vacuum. Why did I use the word "caution"? It's because we recently studied how often a radiation oncology program is comfortable delivering SBRT w/o histopathological confirmation, and the range was between 0 - 61%...

To me, the most important part is the conversation that's had with the patient prior to making a decision. I show the new and old CTs to the patient during consultation and discuss the potential for growth, assumed metastatic potential, etc., with them and get them involved in the decision-making pr...