Prescription dose is far from the full story when it comes to ablative radiation for lung tumors. Here is a review of recent literature on what we can decipher thus far about the impact of prescribing techniques on local tumor control. A primary takeaway: “All dose matters: dose to periphery, max dose, and general dose gradient should be considered when assessing plan quality.” This makes sense as they are all clearly interrelated. Philosophically speaking, for peripheral early-stage tumors, there appears to be little downside to allowing very liberal central hot spots in order to maximize all of the above and resulting tumor control probability. Practically speaking, it appears a central dose of >55-56 Gy in 3 fractions is ideal for small tumors and even higher needed to maximize control for larger T2—in particular squamous cell—tumors. | Owen, Int J Radiat Oncol Biol Phys 2023
