Anyone at SA Breast?

[MidwestRadOnc]

View attachment 383431
View attachment 383432


None of these would match the recent ASTRO PBI guidelines (which again do mention 26/5 as an option). I would follow those. Better for jury explanations.

I love 40/15 as a whole breast dose. (Do we need an argument of 42.5/16 vs 40/15 whole breast?) But this is probably traditionalist of me.

Eventually, we will have data that 26/5 is the standard dose even for ENI. What will all us Americans do then?

I feel like I’m in a senate hearing with Ted Cruz barking for yes or no answers and I’m unfortunately fatty in cowboy boots.

So you either use 26/5 pbi or 40/15 whole breast?

2 questions:
1. Why not 26/5 whole breast when whole breast is indicated.
2. When is whole breast indicated for you for t1-t2 n0 pts?

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[Ray D. Ayshun]

What if we just split the difference and do 28.5 Gy in 5? Has anybody thought of that?

 

[TheWallnerus]

BED2 30/5 = 120 gy
BED2 40/15 + 10/5 = 113 gy
BED2 26/5 = 93.6 gy
BED2 40/15 = 93.4 gy

Pretty convincing data that this math does not clinically pan out (and I'm just as unchuffed as anyone about it) vis-à-vis LC. See IMPORT-HIGH e.g.

Also, I would quibble with your alpha/beta choice of 2 here.

 

[MidwestRadOnc]

What if we just split the difference and do 28.5 Gy in 5? Has anybody thought of that?

No, but some brainiac had the genius idea to test 26 vs 27 when we were content with never testing 40.05 vs 42.56.

Would be hilarious to see a 26 vs 27 vs 28.5 vs 30 trial with the outcome showing inferiority of 27 only. I would not be surprised at all and it Would solidify once and for all the stupidness of this disease site.

 

[TheWallnerus]

I feel like I’m in a senate hearing with Ted Cruz barking for yes or no answers

What if we just split the difference and do 28.5 Gy in 5? Has anybody thought of that?

 

[MidwestRadOnc]

Pretty convincing data that this math does not clinically pan out (and I'm just as unchuffed as anyone about it) vis-à-vis LC. See IMPORT-HIGH e.g.

Also, I would quibble with your alpha/beta choice of 2 here.

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It’s not my choice, don’t shoot the messenger of how doses were selected on trial that the math equates 40/15 to 26/5 biologically, which is the argument that you are making!

 

[RadOncDoc21]

No, but some brainiac had the genius idea to test 26 vs 27 when we were content with never testing 40.05 vs 42.56.

Would be hilarious to see a 26 vs 27 vs 28.5 vs 30 trial with the outcome showing inferiority of 27 only. I would not be surprised at all and it Would solidify once and for all the stupidness of this disease site.

Haven’t said this in over 3 months but always a classic: “Breast is the worst”

 

[MidwestRadOnc]

What if we just split the difference and do 28.5 Gy in 5? Has anybody thought of that?

Coincidentally back when I used to treat a ton of breast I’d have some oddball cases.

Such as a triple negative young patient that couldn’t come in for 4 weeks.

So 26/5 whole breast with 30/5 sib to cavity and 28.5 gy elective to the cavity + ctv margin was exactly what i did. Worked great acutely. Except for the fight with an especially awful man from evicore (im betting you know the one).

 

[Ray D. Ayshun]

Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer

Previous studies of hypofractionated adjuvant whole-breast radiotherapy for early breast cancer established a 15- or 16-fraction (fr) regimen as standard. The FAST Trial (CRUKE/04/015) evaluated normal tissue effects (NTE) and disease outcomes after 5-fr ...

www.ncbi.nlm.nih.gov

I did the winking emoji because it's totally been done. Do whatever the hell you want. It's breast. Tincture of technetium.

 

[MidwestRadOnc]

Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer

Previous studies of hypofractionated adjuvant whole-breast radiotherapy for early breast cancer established a 15- or 16-fraction (fr) regimen as standard. The FAST Trial (CRUKE/04/015) evaluated normal tissue effects (NTE) and disease outcomes after 5-fr ...

www.ncbi.nlm.nih.gov

I did the winking emoji because it's totally been done. Do whatever the hell you want. It's breast. Tincture of technetium.

Having the once weekly option is great and more valuable that landing on that dose. Pts don’t care about dose, they care about logistics. The more options to keep people from absconding the better. I’ve never have to use once weekly yet to sell someone on treatment but it’s been an ace up my sleeve.