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How would you plan sequencing of an MRI-directed prostate nodule micro-boost when doing a sequential plan?
If pursuing a sequential approach with boost to dominant prostate nodules as seen on MRI, what dosing and fractionation would you use in the initial and boost plans?
In your practice do you commonly use sequential boost in this scenario or prefer simultaneous integrated boost?
Answer from: Radiation Oncologist at Academic Institution
Some reports do profile the use of a sequential tumor boost (e.g., Miralbell et al., PMID 19910135); however, I would usually not recommend this unless a brachytherapy boost is planned. Although I could think of a few niche circumstances where there could be a rationale for a sequential boost (...
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Answer from: Radiation Oncologist at Academic Institution
I only use simultaneous integrated boost, as was done in FLAME. I cannot think of a good reason to deviate from that and have not yet encountered one.
@Krishnan Patel had nicely listed reasons SIB is preferred.
Comments
Radiation Oncologist at Radiation Oncology of Rochester, PLLC
Thank you for the discussion. Please correct me if...
Thank you for the discussion. Please correct me if...
Radiation Oncologist at National Institutes of Health Clinical Center
You're correct, although they did observe a relati...
You're correct, although they did observe a relati...
Radiation Oncologist at UC San Diego
That is true. FLAME imposed only a couple of minor...
That is true. FLAME imposed only a couple of minor...
Radiation Oncologist at UC San Diego
Looks like we crossed comments, @Krishnan! I was r...
Looks like we crossed comments, @Krishnan! I was r...
Radiation Oncologist at National Institutes of Health Clinical Center
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Radiation Oncologist at Radiation Oncology of Rochester, PLLC
Thank you again!
Thank you again!
Answer from: Radiation Oncologist at Community Practice
SIB would also lessen the effects of accelerated repopulation that would, in theory, be seen with the increased time necessary for a sequential boost, assuming you're concerned about that with a micronodule boost for prostate cancer.
On the urethral constraint, I don't see any need for one if you a...