Dose constraints for the Turrisi regimen

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XRT_doc

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I can't seem to find the dose constraints for the Turrisi regimen for bid treatment of SCLC. Anyone have them by any chance?

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Would check ongoing RTOG study. Cord max was 36 Gy in original study although mostly from the 30 Gy APPA fields.


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Because their field was large, 1.5-2cm margins on gross dz, bilateral mediastinum, ipsi lateral hilum, and 5 cm below the carina, and the toxicity was limited, you should be fine with any reasonable 3D plan, if you aren't treating elective nodes as they did on that trial. I think the more recent protocol allowed for 40 Gy to cord, V20 < 40% for lung with a mean of around 20ish, 'gus mean dose 34 Gy. Even my dimwitted dosimetrist can put together a plan like that. But, we end up using NSCLC constraints, and then decrease proportionately (about 75%; for example instead of V20 < 30%, aim for 23%). It's not perfect, b/c doesn't take into account overall treatment time, but close enough and limited side effects have been seen.
 
My biggest problem with the Turrisi regimen is what to give to the supraclavicular area. The original trial excluded N3-disease, but I'd like to use the regiment for N3 too.
What am I allowed to give to the plexus?
 
I've had one patient refuse BID in the last several years. Doubt that trial will show much. I just like it because of speed. They get less Gr 3-4 esophagitis then reported in the trial, because the fields are way smaller, but some of them do get a pretty burned up 'Gus.
 
In the current CALGB trial supraclavicular nodes are permitted, and no brachial plexus tolerance is set.

My biggest problem with the Turrisi regimen is what to give to the supraclavicular area. The original trial excluded N3-disease, but I'd like to use the regiment for N3 too.
What am I allowed to give to the plexus?
 
Yes, in 70 Gy arm they will surely see some brachial plexus events.
 
More often than widely recognized, actually.
 
RTOG 0617 had to amended half way through to exclude apical tumors.
 
Thanks for those references, MG, those are useful.

It looks like even with 66-70 Gy, the incidence remains quite low.
Seper - why do you say underreported? Are you seeing it? I never have seen it. I hadn't been contouring it initially, because what I had read in the past indicated that prior to realizing it needed to be contoured, people were blasting it to 66-70 Gy and less than 5% risk of it. With the risk being so low, it would be quite low on the priorities for an IMRT plan.
 
Let's just get Dr. Turrisi to tell us. I'll email him; he should post here shortly. I think some of the things said above re: the trial are wrong, but I'll let him chime in specifically.
 
Personally, I've seen only 2 H&N patients with radiation-induced plexopathy. Hopefully it is because I take pains outlining plexus for every case, and always limit prescription to 68 Gy for large low neck nodes.

Thanks for those references, MG, those are useful.

It looks like even with 66-70 Gy, the incidence remains quite low.
Seper - why do you say underreported? Are you seeing it? I never have seen it. I hadn't been contouring it initially, because what I had read in the past indicated that prior to realizing it needed to be contoured, people were blasting it to 66-70 Gy and less than 5% risk of it. With the risk being so low, it would be quite low on the priorities for an IMRT plan.
 
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