Outside the five.

The Australasion Gastrointestinal Trials Group (AGITC) and the Trans-Tasman Radiation Oncology Group (TROG) have published their guidelines for pancreas SBRT, complete with a step-by-step contouring how-to and detailed dose constraints. They are well thought-out and generated with international expert input to guide their pancreas SBRT clinical trial. But while you’re reading, try to “think outside the five.” Five fractions, that is. We’ve become a little brain-washed into thinking that “ablative” radiation must fit in 5 fractions or less, not in small part due to arbitrary billing rules. If you’re dropping down into the 25 Gy range with your 5-fraction dose, perhaps it’s time you consider alternative ablative fractionation schemes. TBL: Trans-Tasman guidelines recommend 800 cGy x 5 = 4000 cGy during deep inspiration breath hold for pancreas SBRT. | Oar, Pract Radiat Oncol 2019