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Risk adapted fractionation
Total Dose
Relevance of
long-term LC
# of fractions
Dose to critical
serial OARs
• Operable patient
with
stage I NSCLC
• Peripheral location
3 x 18Gy
• Oligoprogressive
stage IV NSCLC
• Central location
5 x 7Gy
07.09.17
Matthias Guckenberger - ESTRO SBRT Course 2017
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Risk adapted fractionation – tumor location
Central location
Chang JTO 2015
• SBRT for central location - standard practice
• Optimal dose and definition of “too” central lacking
3 x 20 – 22Gy
~ 50% severe toxicity @ 2 years
5 x 10 – 12Gy
5 x 10-11Gy: 2 in 34 G3-5 Tox
5 x 11.5-12Gy: 13 in 86 G3-5 Tox
Timmerman JCO 2006
Bezjak IJROBP Supp 2015
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Matthias Guckenberger - ESTRO SBRT Course 2017
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