Is there really substantial evidence to avoid central lesions for SBRT?

Much has been learned since the cautionary data from Indiana University was published showing increased toxicity when using SBRT for centrally-located lung cancers. One should be aware that there is an increased risk when treating tumors in this location with SBRT fractionation schemes. I am aware o...

There might be a larger teaching opportunity related to the Corradetti report. The patient suffered a fatal complication after a biopsy of the irradiated tissue, a result that is akin to a case reported by the Memorial Sloan Kettering group (Cox et al, IJROBP 83(5):e6617-e667). In the latter example...

I agree with @Dr. First Last's comments above. I have been using 50Gy in 5 fractions delivered every other day for the past 3 years for central lesions. The main issue is esophageal injury. I have had 1 or 2 patients develop significant esophageal stricture when the PTV overlaps the esophagus. Dr. Z...

VU University Medical Center regimen (60 Gy in 8 fxs) or U of Rochester regimen (50 Gy in 10 fxs) are also reasonable. I've using them, especially in re-irradiation setting, without any significant toxicities.

For the proton, I would consider 70 Gy in 10 fractions over 2 weeks. Bush et al reported their 12 years experience using passive scattered proton beam on 111 patients stage T1-2 at Loma Linda University in the Red journal (2013, 86(5) pp 964-968) with excellent local control and safety profile. No g...