What’s better than 3-5 fraction lung stereotactic body radiation (SBRT)? Single fraction lung SBRT, of course. Here’s a how-to literature review on the subject. First of all, when it comes to central locations, just don’t do it. Second, motion management and image guidance are more crucial than ever when no other fractions are there to save you from a geographic miss. Next up, dose: three prospective trials have evaluated 30-34 Gy for early-stage NSCLC and four evaluated 23-30 Gy for lung mets—most agree on 30+ Gy—so that’s the range we’re talking about. Conservatively, it can be used on lesions no bigger than 2 cm, though these authors believe the available data supports its use in lesions up to 5 cm, all outside the no fly zone, of course, and at least 1 cm from the chest wall. | Tjong, Clin Oncol 2022
