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It's kind of funny, that I ask this after being an intern in radonc for 4 years now, but:
During my training I was always told by various tutors how important it is to watch out for small bowel late toxicity and always try to limit the dose to small bowel:
"Small volumes of small bowel can be treated up to 54 Gy, but one should be careful when treating large volumes of small bowel with a dose exceeding 45 Gy. One major hope is that small bowel moves from day to day, so that the same bowel segments are not necessarily irradiated every day."
I was also taught that small bowel has a low a/b-ratio (somewhere around 3), so I should be careful with high single doses. This problem may often arise, if one tries to treat cervix uteri patients with HDR-brachytherapy and small bowel lies directly in front / on top of the uterus.
Last week a colleague called to refer a patient that lives near our clinic.
This patient apparently has paraaortal lymph node mets from a corpus uteri carcinoma and is scheduled to receive radiation therapy.
The colleague sent the colleague to us with a letter, stating that they were actually planning to give the patient 64 (!) Gy to the paraaortal lymph nodes.
After seeing the patient and the imaging, I was questioning myself, how they were planning to apply 64 Gy with small bowel inside the PTV.
So, my questions:
How high do you go with the dose when you are treating small bowel (volume dependent)?
During my training I was always told by various tutors how important it is to watch out for small bowel late toxicity and always try to limit the dose to small bowel:
"Small volumes of small bowel can be treated up to 54 Gy, but one should be careful when treating large volumes of small bowel with a dose exceeding 45 Gy. One major hope is that small bowel moves from day to day, so that the same bowel segments are not necessarily irradiated every day."
I was also taught that small bowel has a low a/b-ratio (somewhere around 3), so I should be careful with high single doses. This problem may often arise, if one tries to treat cervix uteri patients with HDR-brachytherapy and small bowel lies directly in front / on top of the uterus.
Last week a colleague called to refer a patient that lives near our clinic.
This patient apparently has paraaortal lymph node mets from a corpus uteri carcinoma and is scheduled to receive radiation therapy.
The colleague sent the colleague to us with a letter, stating that they were actually planning to give the patient 64 (!) Gy to the paraaortal lymph nodes.
After seeing the patient and the imaging, I was questioning myself, how they were planning to apply 64 Gy with small bowel inside the PTV.
So, my questions:
How high do you go with the dose when you are treating small bowel (volume dependent)?
