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Lol. No Choosing Wisely with hypofrac eh?
The per-radiation, extraction only, patient is a money loser so they try to up-sell them on deep cleanings and comprehensive dental care.
My shot in the dark guess is 2 Gy x 18 = 36 Gy. We do the more common 30 Gy / 10 split course here (2 bouts of 3 Gy x 5), and coincidentally EQD2(3) of 3 Gy x 10 is 36.Eighteen fractions is an interesting regimen for Dupuytrens. Can anybody guess what dose this might imply?
My experience is awesome with Radiation Oncology. A lot of my family has Dupuytren's including a brother. I noticed a little tightening in my palm. This would really screw up my career. I had to do some research as RT for Dupuytren's doesn't appear to be common in the states (at least currently). As an example, two hand surgeon friends never heard of it being done. I think there are actual clinics in Europe.
I was able to reach out to a fantastic Radiation Oncologist who was sort of excited to try this. I'm not sure if he ever did it before. Anyway 18 treatments and 3-4 years later I am great. We will never know if it would progress, but I was willing to deal with the long-term ramification if any. I am very grateful. I will admit getting on the table when you are "healthy" sure gets your attention.........lol.
My hand hasn't been an issue for me I haven't really thought about this in 3-4 years. Maybe some of you treat Dupuytren's? What an amazing gift and I am sure it would be a nice adjunct to what you normally do.
My shot in the dark guess is 2 Gy x 18 = 36 Gy. We do the more common 30 Gy / 10 split course here (2 bouts of 3 Gy x 5), and coincidentally EQD2(3) of 3 Gy x 10 is 36.
It is an option and I'd be happy to do it if requested but not a common scenario. Unfortunately we don't have a means to the Dupuytren's patients directly ourselves and as you can tell from your hand surgeon buddies, even the people who actually get referred Dupuytren's are actively clueless regarding the proven role RT plays in managing it. Anytime radiation is mentioned for not a cancer everyone kinda puckers their butt a little bit, while they're just blastin' away at all sorts of benign things over in Germany....
My patients mostly don't have teeth.I haven’t sent for extractions for HNSCC RT in many many many years. Maybe before the previous decade. With good salivary gland sparing (5mm or smaller PTVs help, don’t go wild with CTV margins, etc), sequential and midtx replanning, encouraged dental followup at all times post treatment, I just have not had a single ORN case in practice. So my theory is you really have to “try” to give them the ORN and have a patient with super infaust protoplasm. I like to mentally pat myself on the back at these times and think sequential IMRT vs SIB (and not going up above 2 Gy per fraction to any cells, and BID boosting gross dz at 1.5 per fraction … less late effects… past 50 Gy to quasi replicate concomitant boost fractionation) must have helped.
My patients mostly don't have teeth.