When planning definitive SBRT for localized RCC, how do you approach cases where OAR constraints (such as bowel) compromise PTV coverage?
After fractionating into 5 fractions, would you accept suboptimal PTV coverage? Are there alternative techniques and considerations you might employ, such as referral to a center with online adaptive RT? Is there a point at which you would reconsider procedural approaches, such as surgery?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · University of New Mexico School of Medicine
Answered on
SBRT for localized renal cell carcinoma is a good option when the patient is not a candidate for nephrectomy. In cases where the lesion is directly adjacent to important normal structures, dose reduction is reasonable. If you believe this to be too large of an area, you could consider neoadjuvant sy...
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Mednet MemberInvited Expert
Radiation Oncology
Answered on
This is a relatively common scenario where image guidance is critical to ensure the safe delivery of care. Adjacent bowel can sometimes be dose limiting and due to the mobile nature of this bowel and steep dose gradients at the interface between PTV and bowel in these high dose-per-fraction plans, a...
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