Do you place any constraint on Dmax when developing plans for linac-based SRS or SBRT?

Topics: Radiation Oncology • Neuro-Oncology • Thoracic Malignancies • Stereotactic Body Radiotherapy • Stereotactic Radiosurgery

Answer from: Radiation Oncologist at Academic Institution

Very rarely. I was a gamma knife SRS person before I started linac-based SRS so I am very comfortable with >120% hot spots. For brain linac based SRS we regularly push hotspots to 150% to get the steepest dose falloff (most similar to gamma knife plans prescribing to the 50%...

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Radiation Oncologist at Anderson Regional Cancer Center
@Nadia N. Laack, How do you typically translate th...

Radiation Oncologist at Mayo Clinic
I agree resection cavity SRS you need to careful. ...

Answer from: Radiation Oncologist at Academic Institution

This is the number one thing I see leading to poor quality in linac SRS and SBRT plans, especially when reviewing plans from dosimetrists and physicists who trained on linacs in the era before linac SRS and SBRT became more common. Merely the act of asking in your cost function for homogeneity...

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Radiation Oncologist at Anderson Regional Cancer Center
What control structures should planners use to gen...

Radiation Oncologist at Abramson Cancer Center, University of Pennsylvania
I would suggest there is a major issue here that t...

Radiation Oncologist at Ohio State University James Cancer Center
I would counter that in the lung SBRT literature, ...

Radiation Oncologist at Washington University School of Medicine
Agree with everyone on this one! Agree w/Evan re: ...

Radiation Oncologist at Abramson Cancer Center, University of Pennsylvania
I guess we are getting into semantics about defini...

Radiation Oncologist at Ohio State University James Cancer Center
Haha, sorry, did not mean to call you old Steve! ...

Radiation Oncologist at Abramson Cancer Center, University of Pennsylvania
playful banter and more important with the higher ...

Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System
Great thread! For those of us involved with educat...

Answer from: Radiation Oncologist at Academic Institution

Agree with the hotspot notion. First, we have long history of knowing that it's safe (particularly without intervening OAR). Second, it may well be a driver of control! See our publication on this. Hotspots are a natural consequence of creating highly conformal 3D plans, where the collimator or bloc...

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Radiation Oncologist at Abramson Cancer Center, University of Pennsylvania
interesting - but the change from 3D to IMRT deliv...

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