Topics:
Radiation Oncology • Thoracic Malignancies
How do you approach the management of an early stage non-small cell lung cancer limited to an endobronchial location (non-obstructing) in a patient that is not considered operable due to medical comorbidities?
Do you think these patients are appropriate for SBRT? Is endobronchial laser ablation or cryoablation a better treatment approach? Is there a role for up-front brachytherapy either as monotherapy or as a boost after conventionally fractionated radiation?
Answer from: Radiation Oncologist at Community Practice
We are all aware of the enthusiasm for SBRT in early stage lung cancer. But, if it's because we think it is more likely to help our patients live a long time, then we must always be mindful about the risks of late effects. Once the cartilaginous structures of the bronchus necrose, bad things can hap...
Answer from: Radiation Oncologist at Academic Institution
Generally, favor concurrent chemoradiation to 60 Gy in 30 fractions in these cases particularly if we are talking about the involvement of proximal bronchial tree due to concern for bronchial necrosis and hemorrhage as detailed by Dr. @Moghanaki above. I do frequently utilize SBRT-like hypofractiona...
Answer from: Radiation Oncologist at Community Practice
We have implanted many tracheal and paratracheal malignant lesions with ct-guided permanent seed brachytherapy and have not seen necrosis even in patients who had salvage implant following failed external beam, documented by repeated bronchoscopies.CT-guided permanent seed brachytherapy is a simple ...
I totally agree with the approach of not using SBR...
What dose did you use for brachytherapy in the def...
I have used 30 Gy in 5fx for an endobronchial earl...
I have used the CALGB regimen of 70 Gray in 17 fra...