What dose-fractionation scheme and esophageal constraints should be used to treat an ultra-central, medically inoperable, stage I NSCLC abutting the esophagus?

Topics: Radiation Oncology • Thoracic Malignancies

Is there a safe regimen that still delivers BED >100?

Answer from: Radiation Oncologist at Academic Institution

For lesions abutting the esophagus, SBRT with BED >100 Gy should NOT be used due to high risk for ulceration and even fistula. Instead of SBRT, more fractionated radiotherapy with BED <84 Gy should be considered (60 Gy in 15 FX is still too high for the esophagus). In addition to maximal point...

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Radiation Oncologist at Mon Health
Thank you. Specifically, what fractionation scheme...

Radiation Oncologist at Mallory Radiotherapy, PLLC
I typically treat with 63 Gy in 10 fractions (BED1...

Radiation Oncologist at Mon Health
Thank you. I posed the question in the lung cancer...

Answer from: Radiation Oncologist at Community Practice

I prefer to prescribe 60/15 to the PTV with no more than 45/15 to the esophagus. Gated treatment targeting the GTV (instead of free-breathing targeting the iGTV) is strongly preferred for cases like this.

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Radiation Oncologist at Brooke Army Medical Center
Thank you for the many replies. I greatly apprecia...

Radiation Oncologist at Montefiore Einstein Comprehensive Cancer Center
"Reduce the dose delivered to the GTV in the regio...

Radiation Oncologist at Mallory Radiotherapy, PLLC
It's a really interesting discussion. I guess the ...

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