A_DeMichele
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Are there any sort of data, however minimal, to support this?
Adding nodes to a prostate/SV plan is so marginally harmful, and the benefit is so unknown, I am quick to offer it. We don't know what to do for breast RNI either and lots of people do it.. I would suggest that has a greater hazard than doing pelvic nodez.
Increased GU and GI toxicity. Wouldn't do it for fun. Breast RNI (at least with photons) is WAY less toxic than treating pelvic nodes.Adding nodes to a prostate/SV plan is so marginally harmful, and the benefit is so unknown, I am quick to offer it. We don't know what to do for breast RNI either and lots of people do it.. I would suggest that has a greater hazard than doing pelvic nodez.
56/25 to elective nodal basins?I do 68/25 (56/nodes) and my folks are cruisin' without a bruisin'
Half my patients are constipated, so if anything, its a bonus.
56/25 to elective nodal basins?
Just completely unnecessary. You wanna do 50/25 fine, whatever, variation in practice, but there is zero reason to go above 45.
And the rectum / anus isn’t entirely in PTVNo chemo tho
And the rectum / anus isn’t entirely in PTV
Why?For prostate cancer? I agree that 56/25 is not something I have seen before, but that's a fair argument to be made that even 50.4/28 is not enough to eradicate subclinical disease, which is one of the arguments against ENI at all. How you want to protect the bowel is a different issue, but it's tru that prostate cancer needs a big hammer.
Why?
How many prostate folks are getting 45-50/25 to the nodes and then recurring in those nodes, in-field?
Now that we have PSMA scans I have seen at least 5 of cases of recurrence everywhere but in the elective nodal volume that got around 50Gy.
Because people still recur, in the bed, even after salvage RT. That being said, globally treating people to 64 rather than 70Gy is supported by SAKK trialI believe you, but there are many that are still treating the prostate bed to 70 Gy because they don't believe that 64 Gy is enough to eradicate microscopic disease in the prostate bed (FWIW I only go to 70 if there is a positive margin and I can't identify gross disease on MRI or PSMA)
So, that's a pretty wide gap between 45 is enough for microscopic disease in the nodes but 64 is not enough for microscopic disease in the bed. Conceptually, I see the discordance there.
With IMRT, you could easily dose-escalate the nodal volumes higher while dose-painting the areas adjacent to bowel back to 45-50 (if you wanted to).
Reminds one of breast where ENI sterilizes LN stations but ultimately doesn’t change the overall natural history or OS. I bet, as currently practiced in rad onc across all sites, ENI is not helpful more often than it is helpful. Head/neck guy Sher just irradiated something like 70 head/neck patients with tight PTVs and no ENI and recorded zero percent neck relapses.Now that we have PSMA scans I have seen at least 5 of cases of recurrence everywhere but in the elective nodal volume that got around 50Gy.
I could see someone saying the bed is more hypoxic than the LN.
I have radiated a few head and neck cancer ma without eni (elderly poor performance). Like with lung, you still end up delivering significant doses to nodes most at risk inadvertently. Try giving 70 gy to a tonsil withou giving dose to a junctional level 2 nodeReminds one of breast where ENI sterilizes LN stations but ultimately doesn’t change the overall natural history or OS. I bet, as currently practiced in rad onc across all sites, ENI is not helpful more often than it is helpful. Head/neck guy Sher just irradiated something like 70 head/neck patients with tight PTVs and no ENI and recorded zero percent neck relapses.
One of the great known unknowns in rad onc: how much does “unintentional” ENI work. New thymic carcinoma ABS consensus statements are out in JAMA Onc. I saw where one recommended regimen in one clinical scenario was 16 Gy/8 fx adjuvant hemithorax RT to sterilize microscopic disease. As much as we never use this dose anywhere else for microscopic disease, one still has to admit even just 16 Gy has cancer killing potential.I have radiated a few head and neck cancer ma without eni (elderly poor performance). Like with lung, you still end up delivering significant doses to nodes most at risk inadvertently. Try giving 70 gy to a tonsil withou giving dose to a junctional level 2 node
Let me tell you the good word is upon us.I have radiated a few head and neck cancer ma without eni (elderly poor performance). Like with lung, you still end up delivering significant doses to nodes most at risk inadvertently. Try giving 70 gy to a tonsil withou giving dose to a junctional level 2 node
Let me tell you the good word is upon us.
Have you met our lord and savior Jesus Protons?
This is the wayI’m honestly getting to the point where you should just say f it and just get protons. Just blow the whole operation up and get them. Put all patients on it and call it a day