Rad Onc Twitter

[medgator]

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This conversation again? People worried about <1 percent of women having slightly more swollen breasts, by physician or self?
15 Fx has higher recurrence rates than 5 Fx in trial and also has higher cancer mortality rate than classical fractionation in recent trial.

You're telling me 15fx kills people? C'mon curb

 

[TheWallnerus]

I have one breast surgeon that does fantastic oncoplastic work and still manages to get a nice, well delineated, cluster of clips clinically where I would expect them to be for APBI. For low risk cases I still offer these patients APBI. I think her technique is more of a mastoxpexy though than a ton of "scrambling" of the tissue for lack of a better term.

However, some of the other breast surgeons leave me with no discernable cavity when they do their versions of oncoplastic reconstruction so I face your conundrum and practice like you as well - they typically get 40/15. Elderly patients not concerned with cosmesis that need whole breast I have integrated 26/5 into my regimen.

Even in “oncoplastic” cases (somehow I always, maybe rashly so, figure out where the tumor cavity is), and if low risk, you still have wide-open road to do “less than whole breast” tangents. Above someone was worried that 26/5 is worse side effects than 40/15; but yet when doing PBI I hope everyone uses a 26-30 Gy in 5f dose. That means the same minds who fret that 26/5 is worse than 40/15 for whole breast don’t fret when they apply the same (or more!) 26 Gy dose to a smaller volume. In other words, side effects aren’t just about dose it’s also about volume irradiated. The biggest statistical differences, by far, in terms of toxicity in breast RT trials are in big volume vs small volume irradiated… not in one hypofx regimen vs another.

 

[Palex80]

RTOG 0415 - low risk prostate cancer treated with conventional fractionation vs moderate hypofractionation. Late G2-G3 GI/GU events were increased in the hypofrac arm (~1.4) but was still viewed as non-inferior.

The issue with 0415 may be the high urethral dose.
Very well explained here.

EQD2 (a/b=3 Gy) to the urethra was in 0415 about 8 Gy higher than in CHHiP.

 

[Palex80]

Even in “oncoplastic” cases (somehow I always, maybe rashly so, figure out where the tumor cavity is), and if low risk, you still have wide-open road to do “less than whole breast” tangents.

The low dose bath with PBI to the non-PBI volume of the breast may be even more than one drop of Technetium-99 to the nipple...

 

[Palex80]

Scheduled plan looks all green and fine, but I am gonna take the adapted one, cause I can.
Straight Gangsta.

 

[metallica81788]

Very useful to have that strategy in your pocket for the maybe one time in a career you'll use it

 

[RadOncDoc21]

Very useful to have that strategy in your pocket for the maybe one time in a career you'll use it

Had mine two years ago! The old school way seemed to work out well.

 

[OTN]

View attachment 411898

Scheduled plan looks all green and fine, but I am gonna take the adapted one, cause I can.
Straight Gangsta.

Is the meaningful dose reduction in the room with us right now?

 

[medgator]

Is the meaningful dose reduction in the room with us right now?

Sounds like the argument for protons... History doesn't repeat itself but certainly rhymes

 

[Ray D. Ayshun]

Sounds like the argument for protons... History doesn't repeat itself but certainly rhymes

This is probably an ideal case for protons

 

[radoncftw]

This is probably an ideal case for protons

I actually do treat these cases with protons. Decrease integral dose.
There may not be randomized data...but it makes sense.
Colleague of mine told me they do this at MDACC

 

[NotMattSpraker]

I actually do treat these cases with protons. Decrease integral dose.
There may not be randomized data...but it makes sense.
Colleague of mine told me they do this at MDACC

If everyone wasn't propping up their proton center with elderly breast and prostate, it would be less contentious to treat these kinds of cases.

In my opinion, its extremely reasonable to treat a low volume of AYA patients where it MIGHT be beneficial and we will never have good data to decide.

 

[communitydoc13]

If everyone wasn't propping up their proton center with elderly breast and prostate, it would be less contentious to treat these kinds of cases.

In my opinion, its extremely reasonable to treat a low volume of AYA patients where it MIGHT be beneficial and we will never have good data to decide.

Basically a peds body case. Low prescription dose. Inherent proton dosimetric uncertaintly unlikely to do bad things. Integral dose matters a little (statistically) by most models regarding second malignancy.

Young men famously get nauseated with low doses of abdominal radiation. Curious if protons reduce this acute toxicity.

IRL, most young men are almost opposite to the affluent boomer medical consumer. Rarely do they want to travel for this ish, much less get treatment at all.