Lung

Eligibility

  • If primary lung cancer: non–small cell lung cancer, excluding bronchioalveolar cell cancer
  • Non–surgical candidate
  • 18 years of age or older
  • Tumor size: ≤4 cm
  • Metastatic disease limited to 2 organs
  • No more than 5 metastatic lesions with a controlled primary site
  • Patient condition satisfies simulation and treatment requirements for reproducibility
  • Females must confirm non–pregnant

Protocols

  • Screening spirometry within past 2 months with FEV ≥1.0 DLCO Vo2 max
  • Pulmonary Function test; considered inoperable:
    • FEV1 <40%
    • DLCo2 <40%
    • Vo2 max <10 mp/kg/min
  • Fiducial marker placement:
    • Fiducial marker placement is at the discretion of the radiation oncologist
    • 3–4 seeds around the tumor
    • If fiducials are placed, placement will be performed within 2 weeks of treatment by an interventional radiologist
  • Diagnostic imaging includes:
    • At least a PET scan and CT abdomen/thorax
    • CT to include liver and adrenals
    • Contrast unless contraindicated
    • Imaging studies less than 4 weeks at time of SBRT referral
    • Simulation imaging to occur within 5 days post fiducial marker placement
    • Simulation and imaging positioning:
      • Body fix bag
      • Arms down
      • Synchrony vest with tracking system
    • Prescription
      • 3 fractions of 20 Gy (60Gy) or 5 fractions of 12 Gy for Peripheral Tumors ≥ 3 cm
      • Single dose of 30 Gy or 3 fractions of 20 Gy for Peripheral Tumors < 3 cm
      • 5 fractions of 10 Gy (50 Gy), 4 fractions 12 Gy (48 Gy) for central tumors without intramediastinal extension
    • Prescription lines covering PTV will typically be the 75–85% line; dose will be prescribed to that isodose line which covers at least 95% of the planning treatment volume.
    • Observe current organ dose volume limits
    • SRT to begin with 2 weeks from time of treatment planning
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