Involved Field in Lymphoma?

[Pewl]

---

Members don't see this ad.

Just wondering if anyone even learns about the IFRT standard fields in residency anymore. My impression is that most training programs have moved away from it and the emphasis is primarily on INRT/ISRT. Did anyone go back and try to learn the IFRT fields for oral boards in recent years?

 

[BobbyHeenan]

Just wondering if anyone even learns about the IFRT standard fields in residency anymore. My impression is that most training programs have moved away from it and the emphasis is primarily on INRT/ISRT. Did anyone go back and try to learn the IFRT fields for oral boards in recent years?

I did not learn the classic bony anatomy borders for IFRT. I was fairly familiar with them and in a pinch probably could have rattled them off because we used them toward the beginning of my residency.

I did ISRT for all cases, like NCCN recommends. However, I did a LOT of contouring in my lymphoma section. More than any other section I think. So if you're going to do ISRT, be able to draw your CTV and explain why you're doing it that way.

Maybe others had different experiences (it is pretty examiner dependent), but I didn't waste much time looking at old IFRT field borders.

 

[Gfunk6]

When I took oral boards in 2012, the lymphoma examiner gave me a bit of an eye roll when I told him that I would use IFRT borders. However, the case that was presented had such unbelievably bulky disease, I don't think it would have made a difference. However, during study time with my co-examinees, this was an active area of debate.

Fast forward four years later with the publication of ILROG guidelines, I think you would probably get dinged for using old IFRT anatomy.

 

[seper]

Personally, I'm underwhelmed by the ILROG guidelines paper. It pretty much just implores a radiation oncologist to contour judiciously.

 

[Pewl]

The ILROG guidelines can be summarized by the statement "Please make sure your patient has a complete and thorough workup and contour your volumes carefully using all available imaging."

 

[seper]

Love the part about asking patient family members where lymph nodes were.

 

[Gfunk6]

I agree that the ILROG are underwhelming. What I personally do is perform the same type of contouring and PTV expansion that I would do for IMRT in that site. For instance, for H&N lymphomas I simulate with a thermoplastic mask, contour appropriate pre-treatment disease borders as a CTV and add a 3 mm PTV for planning (assuming daily CBCT).

 

[Damn_Daniel]

From one non-evidenced base guideline to another... And with the only difference between ISRT and INRT being that proper imaging wasn't done pre-treatment... that's just cute. What kind of specialty are we? OB-GYN??