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metastatic bladder case questions
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Yes would wait about a week but if urgent would start right away. Would try to give something hypofractionated like 50/20 (BED of 60) and call it a day
No need to push the dose this high for this case.
I have given xrt on full dose gem for pancreas on protocol in past. Is tolerable; just would keep dose 2-2.5 gy to around 30 Gy. (Been a while but think in pancreas at time 35 at 2-2.5 was what protocol found tolerable)Was it full dose (1000 mms)? If so, a week should be fine.
I also hate concurrent Gem. One of our med oncs loves it for panc and starts everyone at 600 Weekly which is invariably too high. It’s honestly all or nothing. Many patients tolerate it fine but the ones that crash do it in spectacular fashion. Same for concurrent FOLFOX and esophageal. In the absence of compelling data these are necessary I prefer to stick to the tried and true regimens.