Is is okay to offer SBRT for central lung tumors in direct contact with the esophagus?

My short answer is: probably not, if you are considering standard regimens like 10Gy x 5. The risk of fistula appears to be significant if you expose the esophagus to full prescription dose. My group described two patients receiving lung SBRT who developed significant esophageal complications (fistula and GI bleed) in 2014 (Modh A et al, Int J Radiat Oncol Biol Phys 2014) and we subsequently derived esophageal constraints to minimize the risk of esophageal toxicity (Wu A, Radiotherapy and Oncolo...

I appreciate @Dr. First Last's thoughtful response. In response to the question and based on our own data published by my Cleveland Clinic colleague @Dr. First Last [Esophageal dose tolerance to hypofractionated stereotactic body radiation therapy: risk factors for late toxicity., Int J Radiat Oncol Biol Phys. 2014 Sep 1;90(1):197-202, where he demonstrated in our series of 52 patients whose median dose was 50 Gy in 5 fx that fistula was a rare complication], my default answer is: having done th...