How do you approach volumes and dosing when using SBRT for a biopsy-proven NSCLC lung nodule with a central solid component and surrounding ground glass opacity (GGO) appearance?
For small overall volumes (e.g. 0.5cm solid component, 1cm total lesion size when including GGO), I imagine treating the entirety of the abnormality is reasonable; however, what would you do in the case of a 1cm solid component within a 4cm diameter GGO?
Answer from: Radiation Oncologist at Academic Institution
@Kiwhoon Lee, first of all, congratulations on finding our rather obscure article. It's heartening to know that it's impact has reached such high levels that a specific literature search on the topic by my esteemed colleague @Kenneth Olivier fails to find the article. I shall have to resort to ...
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Answer from: Radiation Oncologist at Academic Institution
I would agree. There's no data not to treat the ground glass component. When reasonable, I include all that in the ITV volume. I suppose if the GGO component is > 4 cm, and one run into an issue with normal tissue, I would try to reduce the PTV margin first before lowering the dose to the GGO com...
Answer from: Radiation Oncologist at Community Practice
The only series that I have run across addressing SBRT in adenocarcinoma in situ/minimally invasive adenocarcinoma is one reported by the Washington University group (http://www.ncbi.nlm.nih.gov/pubmed/23286648). From my interpretation of the article, it looks like they included the GGO component in...
Answer from: Radiation Oncologist at Academic Institution
I had a similar situation this week. Patient had a prior Stage 1 (1997) tx with surgery and a GGO that has progressed, now with several small nodules, minimal PET activity, and a biospy showing low grade invasive ACA. The GGO component, however, measures 10 cm and has a very complex shap...