(1/5) The COVID era is a
perfect time to adopt single fraction lung SBRT.  This is supported by two
randomized trials suggesting comparable outcome for 30-34 Gy in 1 fraction for
medically inoperable peripheral stage I NSCLC randomized w 48 Gy/4 fx, and
54-60 Gy/3 fx.  #radonc.

(2/5) RTOG 0915 https://www.ncbi.nlm.nih.gov/pubmed/30513377 
and">https://www.ncbi.nlm.nih.gov/pubmed/30... Roswell Park https://www.ncbi.nlm.nih.gov/pubmed/31445956 
did">https://www.ncbi.nlm.nih.gov/pubmed/31... not demonstrate differences in local control, toxicity, disease free, or
overall survival for single versus fractionated regimens.

(3/5) Trials did not
demonstrate differences in chest wall toxicity rates, but did not disclose how
many lesions abutting CW were randomized. @ManyamRusiaMD published
@ClevelandClinic data correlating tumor location and chest wall dosimetry to
toxicity. https://www.ncbi.nlm.nih.gov/pubmed/30529796 .">https://www.ncbi.nlm.nih.gov/pubmed/30...

(4/5) Virtual consult
( @ClevelandClinic secure platform, or currently even Facetime, GoogleDuo, or
Skype) with images in house, or uploaded remotely ( https://itransfer.ccf.org/themes/guides/ImagingInstituteMock-up.pdf). 
1">https://itransfer.ccf.org/themes/gu... visit for consult & sim, few days later 1 treatment & virtual fup
limits contact and exposure risk.

(5/5) 1 fx not just for
lungCA, also other parallel organs. Karyn Goodman escalated to 30 Gy/1 fx
for liver tumors https://www.ncbi.nlm.nih.gov/pubmed/20350791 ,
a">https://www.ncbi.nlm.nih.gov/pubmed/20... regimen we have likewise found effective for select metastasis, HCC, &
cholangiocarcinoma located away from bowel and central bile-duct.