Spooked.

For years radiation oncologists have been scared of pushing the limits with stereotactic body radiation (SBRT) to the central lung. Welp, RTOG 0813 be damned, these Belgians are calling for an all-out ban. This harrowing Halloween case report details the grade 5 toxicity of a woman treated for...a recurrence of HNSCC at a single distant site ...yeah. A right hilar nodal recurrence received SBRT, and approximately one year later she presented with sudden onset hemoptysis. Imaging and bronchoscopy showed a new “radiation-induced” aneurysm in the right descending interlobar artery protruding into the right inferior lobar bronchus as well as right mainstem bronchus necrosis. In a matter of hours, she was grade 5. If your first thought is that they must have gone rogue with the SBRT dose, they disconcertingly used the very PC dose of 7.5 Gy x 8 = 60 Gy. TBL: Bearing in mind there were four fatal toxicities in RTOG 0813, which still concluded central lung SBRT is safe, radiation oncologists need to come to terms with how much risk is worth taking to cure a cancer. | Ledoux, Cancer Radiother 2019