What are reasonable SBRT dose constraints for the lumbosacral plexus?
In treating an oligometastatic lesion in the sacrum, is it reasonable to extrapolate from RTOG brachial plexus contraints (eg, 8 Gy/fx for a 3-fraction regimen) or is more specific experience available to help guide?
Answer from: Radiation Oncologist at Academic Institution
There are published dose tolerance guidelines for the sacral plexus with the AAPM TG101 report Benedict et al. Med. Phys 37(8): 4078-4101, 2010. Realize these have not been validatedOn page 4086, there is a table with suggested dose constraints for a 3 fraction regimen that include a threshold dose ...
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Answer from: Radiation Oncologist at Academic Institution
Not a direct answer but I would note that without concurrent chemotherapy or prior RT, the tolerance of sacral plexus to conventionally fractionated RT appears quite high, with plexopathy appearing only >77 Gy. This is roughly comparable to conventional H&N brachial plexus constraints (which ...
Answer from: Radiation Oncologist at Academic Institution
Using TG101 or RTOG constraints, I have not seen plexopathies or neuropathies if radiation naive.
Answer from: Radiation Oncologist at Academic Institution
We have published the Indiana University experience of SBRT for apical tumors (led by @Jeffrey A. Forquer who was an IU resident at that time) in Green Journal. Dosimetric correlation with brachial plexopathy was performed and the cut-off was 26 Gy in 3-4 (mostly 3) fractions. This kind of corr...
Comments
Radiation Oncologist at Yale School of Medicine
@Simon S. Lo, do you use the brachial plexus dose ...
@Simon S. Lo, do you use the brachial plexus dose ...
Radiation Oncologist at University of Washington School of Medicine
I do and I think at this point, there are multiple...
I do and I think at this point, there are multiple...
Radiation Oncologist at Radiation Oncology of Atlanta
@Simon S. Lo, what dose fractionation would you us...
@Simon S. Lo, what dose fractionation would you us...