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Would you consider re-irradiation for a prostate local failure for a patient who initially received standard fractionation with a focal SIB to 95 Gy, or a SBRT boost with cyberknife after EBRT?
What dose constraints are you most worried about in the re-irradiation setting with such high doses prior?
Answer from: Radiation Oncologist at Academic Institution
In general, I am not an advocate of re-irradiation for prostate cancer, and I am especially not an advocate of re-irradiation in settings where very high dose boosts have been delivered previously, such as focal SIB, SBRT, or brachytherapy. In this situation, you have demonstrated pretty conclusivel...
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Answer from: Radiation Oncologist at Community Practice
This scenario is not specific enough to generate an acceptable answer, in my opinion. Did this hypothetical local recurrence happen in the 95 Gy PTV zone or, did it relapse intraprostatic but not in the 95 Gy zone?Relapse "in" PTV 95? - Probably notRelapse "outside" PTV 95? - Much more likely t...
Answer from: Radiation Oncologist at Academic Institution
No
Answer from: Radiation Oncologist at Community Practice
There are a couple of investigations and considerations I make when reirradiating in the setting of previous radiation, including high doses:
I always get a PSMA PET in this setting and if there’s an in-field recurrence or edge-of-field recurrence, I order an MRI to characterize the disease...