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Hi, I was wondering if any of you have tried going beyond 45 /1.5 bid in limited disease SCLC.
I have been trying to do this in patients with N1 or limited N2 disease, usually with a stereotactic boost to the affected sites after adaptive planning (for example 1-2 x 5 Gy SBRT after the 45/1.5) or simply adding more fractions (usually up to 51-54 Gy bid) in patients who can tolerate it. I avoid it if the esophagus is in the PTV (so involvement of station 7 is a no-go). I've seen a tiny Japanese series a couple years ago reporting good results:
http://abstract.asco.org/176/AbstView_176_161478.html
I never did 66/2 or 70/2 and after CONVERT results came out, I was happy that I stuck to Turrisi.
Any thoughts?
And since we are already on it:
How do you manage N1 SCLC in terms of target volume delineation of the nodes? Elective nodal irradiation is not necessary in SCLC if you do PET-based planning (probably due to incidental dose), but I am not sure if this can be safely done in N1 disease, since incidental dose to N2 nodes is less if you only treat N1. I've been doing "tailored" volumes (mostly including station 4 & 7 if N1), but that's not really evidence based...
I have been trying to do this in patients with N1 or limited N2 disease, usually with a stereotactic boost to the affected sites after adaptive planning (for example 1-2 x 5 Gy SBRT after the 45/1.5) or simply adding more fractions (usually up to 51-54 Gy bid) in patients who can tolerate it. I avoid it if the esophagus is in the PTV (so involvement of station 7 is a no-go). I've seen a tiny Japanese series a couple years ago reporting good results:
http://abstract.asco.org/176/AbstView_176_161478.html
I never did 66/2 or 70/2 and after CONVERT results came out, I was happy that I stuck to Turrisi.
Any thoughts?
And since we are already on it:
How do you manage N1 SCLC in terms of target volume delineation of the nodes? Elective nodal irradiation is not necessary in SCLC if you do PET-based planning (probably due to incidental dose), but I am not sure if this can be safely done in N1 disease, since incidental dose to N2 nodes is less if you only treat N1. I've been doing "tailored" volumes (mostly including station 4 & 7 if N1), but that's not really evidence based...