Recovery at the Edge of the Limits

Our initial management for this ultracentral oligometastasis1 would have been hypofractionated radiation therapy, 60 Gy in 15 fractions (as per the LUSTRE trial2), using 4-dimensional computed tomography (4DCT) simulation with intravenous contrast, respiratory gating if motion > 7 mm, a 5-mm planning target volume (PTV) margin without a clinical target volume, volumetric modulated arc therapy (VMAT) planning, and 4D cone beam CT scan for matching. No systemic therapy would be incorporated. We would quote a 5-10% risk of grade ≥ 3 toxicity and a 1-2% treatment-related mortality risk, extrapolating from the SUNSET trial.