The first 2 references are for patients with positive para-aortic nodes…
Third ref, is retrospective review, of 36 pts (including 3 with +ve para-aortic nodes), and the conclusion reads Increased toxicity in patients warrants careful patient selection.
And i absolutely agree with their conclusion.
Careful selection would be treat those with positive nodes or PET positive disease, and
omit it for those who have no para-aortic nodes.
Hence no role of treating para-aortic LN routinely as prophylactic intent ..as its too toxic.
Interesting fact about the 1st ref:
Damn, RTOG 92-10, how did they deliver 54-58 Gy to para-aortic region in the late 90s (hyperfractionated) with no IMRT ? ? any idea what BED small bowels and spinal cord would get.
No wonder they had 17% Gr IV toxicity. (unacceptable, and we cant tell pts here… you decide here….dont wanna have that conversation with andrew again) …
I wonder in these modern era, even with para-aortic nodes + ve, what experience do our members have of treating para-aortic LN…. what dose would you go upto ? with concomitant chemoRT of course….
Please specify what you ve done or seen in clinical practice, and not what you think or believe…… lets be practical.
UK practice ..no one has dared to go beyond 50.4 Gy @1.8 Gy / # ——> Routine practice (outside clinical trial)
Canadians ?
Australians ?
Nikhilesh Patil, 18 Apr 2011 17:58