IMRT rectal cancer

[CUBuffsgrad98]

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Anyone doing IMRT for rectal cancer? Or still just 3D standard 3 field? Saw a multiinstitutional paper published recently with IMRT having significantly less toxicity than 3D, but not sure if it has crept into the community yet?

 

[seper]

pretty universally adopted on East Coast, as I far as I can see

 

[CUBuffsgrad98]

NCCN says: IMRT should only be used in teh setting of a clinical trial or in unique clinical situations including reirradiation of recurrent disease after previous radiotherapy.

In this situation it is a 73 year old guy with T4 disease (thus external iliacs covered), seems like IMRT will spare him a lot of potential toxicity.

 

[OTN]

I usually try to when a fair amount of small bowel is within the pelvic field, but I've had a very tough time getting it routinely approved by payors.

 

[Gfunk6]

Low-lying rectal cancer/T4 definitely necessitates IMRT in my view (unless you are still treating anal cancer AP/PA!) since you have to cover inguinal/external iliac LNs. Anecdotally, I have noticed significantly improved GI toxicity with IMRT > 3D when you push the OAR limits on potential small bowel. I agree that it is a crapshoot getting it approved through payors although I learned that it is accepted as standard by Anthem (at least in my neck of the woods).

If I really need IMRT and the payor is still resistant, I sometimes send over IMRT/3DCRT comparison with the relevant dosimetric objectives highlighted. This still doesn't always work and it eats up precious time that you could be treating instead.

 

[thesauce]

Rectal is now all IMRT here

[enter gastrorads]

 

[medgator]

I usually try to when a fair amount of small bowel is within the pelvic field, but I've had a very tough time getting it routinely approved by payors.

Same here. I think Cigna and United have both shot me down before.

 

[OTN]

Low-lying rectal cancer/T4 definitely necessitates IMRT in my view (unless you are still treating anal cancer AP/PA!) since you have to cover inguinal/external iliac LNs. Anecdotally, I have noticed significantly improved GI toxicity with IMRT > 3D when you push the OAR limits on potential small bowel. I agree that it is a crapshoot getting it approved through payors although I learned that it is accepted as standard by Anthem (at least in my neck of the woods).

If I really need IMRT and the payor is still resistant, I sometimes send over IMRT/3DCRT comparison with the relevant dosimetric objectives highlighted. This still doesn't always work and it eats up precious time that you could be treating instead.

Completely agree with low-lying. When I need to cover inguinal nodes I exclusively use IMRT and actually haven't had much trouble getting it approved...once I'm able to talk to someone who understands radiation.