Do you require a biopsy prior to SBRT for pulmonary metastases from oligometastatic disease?

A biopsy of a lung mass can be central to the appropriate management of your case. Some of the risk factors for GI cancers and lung cancers are the same, ie smoking. We have had several patients with anal cancers who have subsequently been found to have synchronous lung cancers with different histologies than their anal cancers. If a primary lung cancer were discovered, your choice of management may be different than SBRT, especially if your management of the anal cancer, for example, is definit...

I completely agree with Salma. The preference is to biopsy whenever possible for the above listed reasons. There are certainly instances where biopsy is not feasible but usually these situations are limited.

On a slightly different note, during residency I was never thaught much about the medical-legal implications of a treatment decision. I recently reviewed a case for someone who treated a malignancy without a biopsy comfirmation. The patient ended up dying from a complicated wound infection....

Neal, I can't agree with you more. In the midwest, a suspicious lung nodule may well be histoplasmosis which can also light up on PET. Many years ago, I treated a child with Hodgkin lymphoma who developed a lung nodule that was hot on PET after completing 4 cycles of chemotherapy. The choices were to proceed with consolidative RT, treating both lungs using 1 HVL lung blocks, or to biopsy/ resect the lung nodule. Her Hodgkin lymphoma was in near CR and it was hard for me to believe it was progres...