Sorry, I should've specified hypofrac for non-poor PS patients (like still going to nonpalliative doses)
FAST-FORWARD used whole breast and they have good descriptions of contouring and constraints in the paper. But 5-fraction APBI is acceptable too per the Italian trial.
Gotcha
Agree but the B-39 trial was overall much better run than the Livi trial and I don't want to deal with insurance crap about using IMRT for any form of breast. I often do B-39 QD instead of BID as well. I am not familiar with the FORWARD trial - do you mean FAST? I don't pay much attention to FAST because it's a smaller trial because its primary endpoint was not tumor control. FAST-FORWARD's was and I will be waiting for 10 year data on FAST-FORWARD, especially for left-sided cases as I am concerned about even smaller heart doses since it's 5 fx.
Honestly definitive lung minus chemo is palliative so no need to go to 60/15, 45/15 should be fine if no chemo given.
My bad, as I posted above I meant this in the sense of young/fit patients who would get 60/30 normally, I don't know of data using hypofrac for those settings (Palex's idea is a good one though...w/o data)
Agreed, although I will use 5 fraction more in patients with immunotherapy because who knows if durable local control is important for them. 8/1 is perfectly fine too.
I use 5x5 like Europe, little extra oomph similar to 30/10
Good luck finding many cases like that, especially liver.
I hear you. If pt is compliant and daily CBCT done then I'm not worried. If that's the case what do you think about something like 62/20 either to the whole PTV or SIB to the prostate CTV? Not the trial dose but addresses your concerns too...
My concerns are addressed by 70/28.
Anybody notice #RadOncRocks has been pretty scarce 'round Twitter these days
I guess it depends on how you define greatness. In my experience, nine weeks of radiation therapy for prostate cancer was frequently dismissed out of hand by patients who had lives to live and as a result chose radical prostatectomy because it took less time. I am not saying this was wise on their part but it happened. Now I can offer many men 4-5 weeks or even 4-5 treatments and I see many are considering radiation as an alternative. Surgeons are complaining in public and private that short courses are creating competition. The large NI trials reassure some of us (not all of course) that these shorter courses are safe and effective and without question more convenient for patients. Many patients appreciate this.
I'll take rad onc over a "normal specialty" any day. Because unlike them, we read and rationalize...instead of turning off their brains and giving their drug or cutting the patient.
By that logic I am sure conventionally fractionated breast RT can also be considered one of the "standards of care" too.
Hypofx breast rt improved outcomes compared to conventional (better cosmesis/side effect profile). Is the same true for hypo vs conventional prostate RT?
In my view there is no risk of a higher acute toxicity with hypofractionation. I would rather say that acute toxicity arises earlier in hypofractionation and perhaps a bit steeper, but would you measure the area under the curve in terms of toxicity it's probably the same with hypofraction or normofraction.
Would it be fair to say 74 gy is under treatment?
Some randomized studies have shown this (e.g. MDACC trial) but other have not (e.g. Whelan), so this remains an unresolved issue.
Not in the UK and there is no evidence of a survival benefit above 70 gy. PROFIT compared 60 gy in 20 fractions to 78 gy and found no difference; in fact late gr2 GI toxicity was lower with hypo.
The numerologists at MSKCC like 81.
angelnumber.org
