SBRT lung margins

[Gfunk6]

A few comments to other posters:

1. Yes, I've treated without biopsy before. However, standard of care in most cases is to biopsy.
2. There are plenty of reasons that a CK can nicely complement existing linacs - our practice has five linacs in addition to CK. These include complex re-irradiation cases, small targets or those near critical structures, etc. Also, there is the marketing angle which is regionally specific. We often get self-referred patients to our CK facility - some of them are not suitable candidates but we still keep them internally for conventional radiation or chemo - the so-called "halo" effect.
3. As noted above by medgator, the Edge is essentially a neutered TruBeam.

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[thecarbonionangle]

CK is a great marketing tool along with MRI linac. It is a poor man’s protons. It uses a knife man, wouldnt you want that? And i have seen youtube videos of “the robot” dancing. Very cute stuff

 

[communitydoc13]

Is this not common in the community?

Common here. Treat all the time without biopsy.

1) enlarging on multiple scans + 2) PET-avid +3) pt a smoker + 4) either biopsy is considered 'unsafe' by pulm/IR or two attempts were made

Good list IMO. Upper lobe, spiculated, solitary all make malignancy much more likely.

All pts discussed in MDC.

Multiple nodules, known diagnosis of RA, lower lobe in non-smoker, smooth appearance all make malignancy less likely but even in these cases progression with PET avidity often enough for me to treat when biopsy excessively risky.