Would you offer lung SBRT to a medically inoperable patient with systemic lupus erythematosus or other connective tissue disorders if well controlled?

This is a very timely and clinically relevant question that had intrigued us for quite a while.

Thus, we looked into our over 10 year experience at UCLA for 197 adult patients with collagen vascular disease. This work was recently published in JAMA Open Network: Yoon et al., PMID 33599771.

The hypothesis was that with modern radiotherapy fields and techniques, accounting for smaller treatment volume and better conformity, SBRT or ultra hypo fractionated radiotherapy should be safe in a majority of these patients, especially those that have well-controlled disease.

Indeed, the overall incidences of severe acute toxic effects associated with conventional fractionation, modest hypo fractionation, and ultra hypo fractionation, were low (5.4%, 7.4...