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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?
4 Answers
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Radiation Oncology · University of North Carolina
Answered on

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 validated

On page 4086, there is a table with suggested dose constraints for a 3 fraction regimen that include a threshold dose ...

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Radiation Oncology · The Ohio State University - James Cancer Hospital and Solove Research Institute
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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 are des...

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Radiation Oncology · University of Washington School of Medicine
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Using TG101 or RTOG constraints, I have not seen plexopathies or neuropathies if radiation naive.

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Radiation Oncology · University of Washington School of Medicine
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We have published the Indiana University experience of SBRT for apical tumors (led by @Dr. First Last 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 corroborated ...

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