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Do you base liver SBRT dose fractionation on size, volume, or proximity of normal tissue?

For example, would you use a cutoff such as PTV of 25 cc, or 4 cm diameter, or simply use nearby normal tissue constraints to alter your fractionation from 20 Gy x 3 fractions to a more fractionated course?
3 Answers
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Radiation Oncology · Memorial Sloan-Kettering Cancer Center
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I think about this differently than most people do. My goal is to deliver an ablative dose (100 Gy BED) regardless of the proximity of organs at risk or the size of the tumor. The more common thing to do is to reduce the dose of radiation below an ablative dose to 40 or 30 Gy in 5 fractions. I'm not...

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Radiation Oncology · University of Colorado School of Medicine
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@Dr. First Last's paper (Tao et al., PMID 26503201) is a very good report on IHC, and given the fact that few other institutions can accumulate such a sizeable experience, I think it is hard to argue with their nuanced approach in that setting. Their discussion acknowledges all of the caveats inhere...

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Radiation Oncology · Memorial Sloan-Kettering Cancer Center
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The stricture risk with 3-5 fraction SBRT is still probably an open question for small non-biliary tract cancers. It is a resistant structure, but the consequences can be high, anywhere from lifelong dependence on stent exchanges to cholangitis or even death if a stricture develops. I have seen anec...

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