How would you approach a patient with acute development of radiation changes around the target while undergoing a course of lung SBRT?
The answer to this question is dependent on the dose/fractionation of lung SBRT being employed. For example, at our institution, we preferentially use single fractions for peripheral lesions and for fractionated central dose schedules such as 50 Gy in 5 fractions, we do not gap the treatments but tr...
The issue of change in the appearance of a lung nodule on cone beam during treatment is, in my mind, straightforward - sort of... I agree with Dr. @Dr. First Last on fractionation schema and we typically use the fewest fractions possible i.e., single 30 Gy, 54 Gy in 3 but for targets near the ribs o...
Acute radiographic changes seen on CBCT within a few days of lung SBRT may not be fibrosis and instead be an artifact of image acquisition. I'd confer with a medical physicist to first rule out the likelihood of technical aberrations. Then, one can decide whether to dive into pathophysiological hypo...
Although rare, we did have a patient who developed radiographical radiation pneumonitis after 4 of 5 planned fractions of SBRT to the lung (40 Gy total). We were giving every other day treatment. The patient did develop symptomatic pneumonitis some weeks later and required steroids for 6 months.
Th...