How do you treat non-spine bone oligometastases?
If a patient has a single oligometastatic bone lesion of the pelvis from lung adenocarcinoma, what is your preferred dose/fractionation scheme for SBRT?
Do you rely on MRI to delineate the osseous lesion, or is CT or PET/CT imaging sufficient?
What margins do you typically employ, and where do you derive dose constraints from?
3 Answers
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Radiation Oncology · The Ohio State University - James Cancer Hospital and Solove Research Institute
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- Get the MRI. It is proven to reduce inter-observer variability in contouring (Raman et al., PMID 29748100). More philosophically, sometimes you'll see something more, sometimes you won't. But the only way to know is to check. And if this treatment is worth doing, it's worth doing accurately -- espe...
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Radiation Oncology · Michigan Healthcare Professionals, PC
Answered on
Just some thoughts from a non-expert.
My preference for non-spine is 30 in 3 (BED10 of 60). I see 30 in 5 often, but that feels "wimpy" (BED10 of 48). If preference is 5 fx (which is prevalent in community practice), then 35 in 5.
I don't love a single fraction. I don't have evidence for it, but I t...
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Radiation Oncology · Steward Medical Group
Answered on
Minimum BED for ablation is approximately 100, and 50 Gy in 5 fractions achieves this for a rib lesion. Beware of rib fx risk of 10-20%. In other areas, be aware of neural toxicity. May need to lower the BED expectation.
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