What is your thought process for dose prescriptions when treating abdominal/pelvic lymph node oligometastasis with SBRT?
For that occasional "single lymph node metastasis" referral in patients with no other sites of disease, is there a therapeutic dose below which you're not really helping the patient? Perhaps the BED equivalent of 30Gy in 10 fractions? I haven't been able to achieve the doses reported in the (very limited) literature, while staying within the normal tissue constraints (that are minimally validated). I wonder if there is any benefit to a low dose like 6Gy x 3 when treating a para-aortic/pelvic lymph node met.
Answer from: Radiation Oncologist at Academic Institution
I don't love SBRT for nodal mets aside from unique situations. Although I agree they may represent a less aggressive phenotype than hematologic parenchymal mets they are also connected to their neighbors in a way a bone met isn't. SBRT is a very focal therapy when done well and so neighb...
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Answer from: Radiation Oncologist at Academic Institution
In oligometastatic disease, LN metastases are generally thought of as relatively favorable prognosis-same category as bone mets (worst prognosis would be adrenocortical and brain). If that is the case, I would favor more aggressive dosing for a solid tumor primary—in the case of a lympho...
Answer from: Radiation Oncologist at Academic Institution
I agree with the previous thoughtful responses from Drs. @Yoshiya Yamada and @Kenneth Olivier. Two other points i'd like to build on:
1. Patient selection.
We shouldn't treat LNs with SBRT just because we can. Need to consider:
patient factors (anything that increase risk? ILD/IPF for int...
Answer from: Radiation Oncologist at Community Practice
To add to the prior excellent comments, I agree that with nodal metastases one may need to be more concerned about micrometastases in the adjacent tissues (nodes) than perhaps with other sites of oligometastases. I've had good tolerance and long term disease free survivals with a dose painting appro...
Answer from: Radiation Oncologist at Community Practice
Here is our data on reradiation for node for gyne cancer.