Topics:
Radiation Oncology • Thoracic Malignancies • Stereotactic Body Radiotherapy • Non-small cell lung cancer
Should lung SBRT fractions be delivered on consecutive days, every other day, or perhaps an even more prolonged schedule?
Does tumor location play a role (central vs peripheral) in making the decision? The question stems from an oral presentation at ASTRO 2014 investigating the hypoxic tumor volume after SBRT (http://www.redjournal.org/article/S0360-3016(14)00777-9/fulltext). The hypoxic tumor volume doubled 48 hours after a SBRT fraction and came back to baseline 96 hours after SBRT on 18F-FMISO PET.
Answer from: Radiation Oncologist at Academic Institution
I think the polling results should be taken with a grain of salt. While most of us continue to give 54/3 for peripheral lesions based on our comfort level enrolling on RTOG 0236 and the significantly larger doses being given, at least for 5 fx regimens the data suggest no difference in toxicity or c...
Answer from: Radiation Oncologist at Academic Institution
This is a great question. Which is really just another way of saying "I don't know the answer." The reference that the questioner cites is a patient that we treated on a prospective study of tumor hypoxia using FMISO PET/CT scans - we've now observed a significant increase in tumor hypoxia after t...
Answer from: Radiation Oncologist at Academic Institution
There was also a multi-institutional retrospective study that looked at this question for patients with ≥5-cm NSLC treated with SBRT of 5 fractions or less. They found fewer overall and pulmonary grade ≥2 toxicities for patients treated every with non-daily regimen...
Answer from: Radiation Oncologist at Academic Institution
Nobody knows the correct answer.... but having treated well over 1000 lung sbrt patients I look at it a bit pragmatically. The results, particularly when it comes to things like colorectal mets, look a tad better with every other day. I would also do every couple of days for 54/3. So overall, I ...
Answer from: Radiation Oncologist at Community Practice
This more recent article from Sampson in PRO may help shed more light on this question in favor of QD treatment (https://www.ncbi.nlm.nih.gov/pubmed/29907514): modern technique SBRT treated within past 3 years (analysis limited to 2015-2016) instead of 2003-2014 in the Alite, et al paper referenced ...
Answer from: Radiation Oncologist at Community Practice
Someone looked at this. Check it out. https://www.ncbi.nlm.nih.gov/pubmed/27543255There's another paper from one of the Toronto programs that looked at this question prospectively for pneumonitis rates. I'll post it when I can find it again. EDIT:My bad, it was from the UK.https://www.ncbi.nlm.nih....
Comments
Radiation Oncologist at Anderson Regional Cancer Center
When doing the hypofractionated, SBRT-like regimen...
When doing the hypofractionated, SBRT-like regimen...
Was the paper from 2014 presentation ever publishe...