Can I treat breast nodal volumes with hypofractionation?
With the recently reported START (A and B) trial data from the UK, in which patients were allowed to receive hypfractionated doses to nodal regions, is it acceptable practice to treat supraclav/axilla regions with hypofractionation?
Answer from: Radiation Oncologist at Academic Institution
Yes. Published randomized trials have treated/reported 2,000 patients with doses of >2 Gy in hypofractionation vs standard fractionation trials with treatment to the axilla. Trials include Start A/B (513 patients), the old trial by Ragaz et al., PMID 15657341 (318 patients, hypox 37.5 Gy in ...
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Radiation Oncologist at Tennessee Oncology @Rachel A. Rabinovitch - do you treat the chest wa...
Radiation Oncologist at University of Colorado School of Medicine We do at U of Colorado - based on the internationa...
Radiation Oncologist at Maryland Oncology Hematology What lung dose constraints do you use? What percen...
Radiation Oncologist at Varian Medical Systems/Allegheny health network We use similar numbers. Some use V18 to account fo...
Radiation Oncologist at University of Colorado School of Medicine @Neha Bhooshan - we use 40 Gy/15 for all PMRT/RNI ...
Radiation Oncologist at Willis Knighton Cancer Center It has been the policy at our center for years now...
Answer from: Radiation Oncologist at Academic Institution
The above discussion is wonderful. I'd like to add a bit by looking to the future. I am aware of 7 active RCTs evaluating the safety and efficacy of moderate hypofractionation and 2.5 RCTs evaluating extreme hypofractionation in RNI. Ultimately, we will have a large dataset from diverse countries to...
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Radiation Oncologist at University of Colorado School of Medicine Thanks, @Jonathan B. Strauss! I actually got off t...
Radiation Oncologist at Hollings Cancer Center, Medical University of South Carolina Outside of clinical trial, do you ever offer hypof...
Radiation Oncologist at Northwestern University @Rachel A. Rabinovitch. That's exciting. I'll be l...
Answer from: Radiation Oncologist at Academic Institution
At our institution we are running two sister trials of hypofractionation for intact breast and PMRT patients, in which we allow nodal RT with the same shortened schedule. I get a lot of questions on this, specifically with reference to our rationale/consideration of brachial plexopathy toxicity. W...
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Radiation Oncologist at Tel Aviv Sourasky Medical Center, Israel Hi. Considering what we know now (2020), and more ...
Radiation Oncologist at Cleveland Clinic Absolutely; I routinely offer hypofractionated reg...
Radiation Oncologist at Virginia Commonwealth University School of Medicine Thank you. In cases when you do offer hypofraction...
Radiation Oncologist at Retired This race to decreasing treatment is perplexing. W...
Radiation Oncologist at University of Colorado School of Medicine Good points. I'd point out the following. 1) Most ...
Radiation Oncologist at SwedishAmerican Regional Cancer Center @John P. Petersen I had the exact same thought reg...
Answer from: Radiation Oncologist at Community Practice
I would personally caution the use of hypofractionation for nodal volumes due to the late risk of brachial plexopathy and would suggest that even 5 years of follow-up does not allow for adequate time to assess the risk of nerve damage. Khan et al., PMID 28900318
Galecki et al., PMID 1664...
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Radiation Oncologist at Cleveland Clinic There are long-term data from START patients treat...
Radiation Oncologist at Varian Medical Systems/Allegheny health network It’s the same with hypo fractionation for br...
Radiation Oncologist at Cancer Center of Hawaii Thanks for pointing out the article on late effect...
@Rachel A. Rabinovitch - do you treat the chest wa...
We do at U of Colorado - based on the internationa...
What lung dose constraints do you use? What percen...
We use similar numbers. Some use V18 to account fo...
@Neha Bhooshan - we use 40 Gy/15 for all PMRT/RNI ...
It has been the policy at our center for years now...