Wanted to review how you guys would approach this
Got an elderly guy, GOLD 4 COPD, FVC 1.8L, 45% predicted, FEV1 860cc, 28% predicted, FEV1/FVC ratio 47%, with a peripheral early stage NSCLC, about 1.5cm, close to the chest wall, biopsy proven, PET negative, MRI brain negative. No matter what we did, tumor movement was 2cm+ on 4D, even after re-sim, plate/belt, education, etc. I've heard off hand that if movement >1cm you should not do SBRT, others say it is OK if it is a small target.
What is your go to regimen in this situation? Still do SBRT? I was initially thinking 50/5, its far away from OAR's, other than chest wall, which I would optimize to but would probably not meet. Otherwise was thinking 60/15 or 70/20...thoughts?
Got an elderly guy, GOLD 4 COPD, FVC 1.8L, 45% predicted, FEV1 860cc, 28% predicted, FEV1/FVC ratio 47%, with a peripheral early stage NSCLC, about 1.5cm, close to the chest wall, biopsy proven, PET negative, MRI brain negative. No matter what we did, tumor movement was 2cm+ on 4D, even after re-sim, plate/belt, education, etc. I've heard off hand that if movement >1cm you should not do SBRT, others say it is OK if it is a small target.
What is your go to regimen in this situation? Still do SBRT? I was initially thinking 50/5, its far away from OAR's, other than chest wall, which I would optimize to but would probably not meet. Otherwise was thinking 60/15 or 70/20...thoughts?