COVID-19 RT emergent management - RadOnc Tables Estes

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1	Timestamp	NAMA AGEN SILVER	JUMLAH KODI

2	4/8/2021 4:45:09	Yus	20

	A	B	C	D	E	F	G	H	I	J	K	L	M
1	Site	Subtopic	Eligibility	Trial/Group	Dose/fx	Dose constraints	Notes	OS benefit vs obs?	Evidence level?	Link	Link	Link	Link
2	Prostate	low	low		defer

3	Prostate	int	int		ADT
4	Prostate	high	high		ADT
5	Prostate	salvage	salvage		ADT
6	Prostate	Ultrahypofx	low to high risk	HYPO-RT-PC	42.7 Gy/ 7 fx IMRT	Delivered QOD 3DCRT, IMRT, or VMAT (not SBRT) Dose constraints Rectum V38.4 < 15%, V32 < 35%, V28 < 45% (Bladder constraints were omitted) Femoral heads max < 29.9 Gy CTV Dmin > 95% PTV D90 > 90%, V95% > 95%		in high risk	1 - noninferior	https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31131-6/fulltext#articleInformation
7	Prostate	Ultrahypofx	high risk, M1, or any age >75	STAMPEDE	36 Gy/6 fx once weekly IMRT/SBRT	Delivered once weekly The protocol allowed 3D and "equivalent coplanar techniques" that use MLCs: presumably both IMRT and SBRT. Dose constraints for 6 fractions Rectum V50 <33.3 Gy, V60 <27.8, V80% <16.7 Bladder V25% <33.3, V50<27.8		in high risk	1 (vs no RT)	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6269599/
8	Prostate	SBRT	low to high risk	MSKCC NRG GU005	36.25-40 Gy/ 5 fx SBRT	NRG GU005 Rectum D0.03cc<38.06 Gy (variation acceptable <40) D3cc<34.4 Gy (VA <40) D10%<32.63 (VA <34) D20%<29 (VA <30) D50%<18.13 (VA < 19) Bladder D0.03cc<38.06 (VA <40) D40%<18.13 (VA <20) Urethra D0.03<38.78 (VA <43.5) Rec but not required: Penile bulb D0.03cc <100%, D3cc <19.9 Gy MSKCC phase I dose escalation average PTV D95 within 95-101% average PTV D98 within 89-100% 3 mm rectal wall: max < 103%, D1cc< 38.5 Gy, D53%< 24 Gy, V30.15 Gy < 8 cc Bladder wall: max < 105%, D1cc< 42 Gy, D53%< 24 Gy		in high risk	phase I-II	https://www.redjournal.org/article/S0360-3016(18)34227-5/pdf	https://clinicaltrials.gov/ct2/show/NCT03367702
9	Prostate	mod hypofx	low to high risk	CHHip	60 Gy/ 20 fx	CHHiP rectum V20 <85%, V30 <57%, V40 <38%, V50 <22%, V60 <0.01% bladder V60 <5%, V48.6 <25%, V40.8 <50%		in high risk	1 - noninferior	https://www.redjournal.org/article/S0360-3016(18)31103-9/fulltext	https://www.redjournal.org/article/S0360-3016(18)31103-9/fulltext	https://www.ncbi.nlm.nih.gov/pubmed/28296582
10	Prostate	mod hypofx	node positive		20 fx				retrospective	https://pubmed.ncbi.nlm.nih.gov/30718087/
11	Prostate	mod hypofx	node positive		5 fx				retrospective	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460324/
12	Prostate	Prostate general	N0 M0	RTOG 9413 NCCN	Omit Prophylactic WPRT		Unpublished RTOG 9413 data suggesting increased risk of lymphopenia	no. Possibly DM benefit in RTOG SPPORT	1	https://www.nccn.org/covid-19/
13	Prostate	salvage	salvage	NRG GU003	62.5 Gy/ 25 fx	NRG GU003 Rectum V36< 55 (variation acceptable <60) V59< 35 (VA <39) Bladder V35< 70 (VA <77) V57< 50 (VA <55) Femoral heads D44 <10 (VA <11) Small bowel not specified - used BED calculations		yes for SRT within 2 years of RP if PSA DY <6mo (JAMA. 2008;299(23):2760-2769)	ongoing protocol	https://clinicaltrials.gov/ct2/show/NCT03274687
14	Prostate	salvage	salvage	Christie, Manchester, UK RADICALS	52.5 Gy / 20 fx	per RADICALS: Bladder 40 Gy < 80% 48 Gy < 50% Rectum 24 Gy < 80% 32 Gy < 70% 40 Gy < 60% 48 Gy < 50% 52.5 Gy < 30%	This fractionation was an option in RADICALS, as was conventional fractionation.	yes for SRT within 2 years of RP if PSA DY <6mo (JAMA. 2008;299(23):2760-2769)	retrospective, prospective (an option on RADICALS - reported in abstract)	https://doi.org/10.1016/j.ijrobp.2020.01.008	https://www.esmo.org/Press-Office/Press-Releases/ESMO-Congress-prostate-cancer-surgery-radicals-artistic-Parker-Vale
15	Bladder	preservation	T2-T4a	BC2001	55 Gy/ 20 fx	Full dose delivered to tumor and 80% dose (=44 Gy) to uninvolved bladder with CCB Use BED calculations: Small bowel <53 Gy. (The trial was mostly performed during 2D planning era with some 3D. Thus no dose constraints were outlined in BC2001 other than rectum max <80% rx dose.) If tumor is adjacent to small bowel, the high dose PTV may need to be undercovered	On a later combined analysis, hypofractionation was found to be noninferior. The initial trial, BC2001, found that the regimen was not noninferior, but was close to, standard therapy.	Preservation is intention	noninferior	https://ascopubs.org/doi/abs/10.1200/JCO.2017.35.6_suppl.280	https://www.eventscribe.com/2019/ASTRO/fsPopup.asp?Mode=presInfo&PresentationID=559471

	A	B	C	D	E	F	G	H	I	J	K	L
1	Site	Subtopic	Eligibility	Trial/Group	Dose/fx	Dose constraints	Notes	Evidence level?	Link	Link	Link	Link
2	Rectal cancer	locally advanced	locally advanced	Poland, Shanghai, TROG, Stockholm	25 Gy/ 5 fx	Field: traditional rectal pelvis fields. Dose constraints may not be required, only blocks? Avoid hotspots. A contributor writes: @WashU we use small bowel max < 25 Gy. If you use 4 field with FIF you should be able to meet this constraint with most plans (I accept up to 2550 cGy small bowel max if it is completely in field). Feel free to reach out if questions.		phase III	https://www.ncbi.nlm.nih.gov/pubmed/25466851
3	Rectal cancer	locally advanced T4	locally advanced T4b	Poland, Shanghai, TROG, Stockholm	25 Gy/ 5 fx			expert committee
4	Rectal cancer	min T3	minimal T3, minimal N1-2 not extranodal	Poland, Shanghai, TROG, Stockholm	25 Gy/ 5 fx or observe			phase III
5	Rectal cancer	inoperable		PMH	52 Gy/ 20 fx			retrospective	https://pubmed.ncbi.nlm.nih.gov/7836077/
6	Anal	without concurrent chemo	no concurrent chemo	PMH	40-50 Gy/ 20-25 fx			prospective	https://www.redjournal.org/article/0360-3016(91)90265-6/fulltext	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945520/pdf/oncotarget-09-20439.pdf
7	Anal	without concurrent chemo	no concurrent chemo	Nigro	30 Gy/ 10-15 fx			retrospective	https://pubmed.ncbi.nlm.nih.gov/4830803/	https://pubmed.ncbi.nlm.nih.gov/7215078/	https://pubmed.ncbi.nlm.nih.gov/6831348/
8	Pancreatic Cancer	borderline inoperable	borderline	various	25-50 Gy/ 5 fx consider SIB to vessels	CTV optional. Consider extending posteriorly to vessels. PTV 5 mm. Gating or 4DCT TROG and AGITG guidelines (5 fractions) Duodenum/small bowel/stomach Dmax 0.5 cc <33 Gy (VA <35) V30 <5 Gy (VA <10) Duodenum/small bowel/stomach PRV Dmax 0.5 cc <38 Gy (VA <40) PTV40 D99 >30 (VA > 25) PTV40 EVAL D90 >100 (VA > 90) CTV D99 > 33 (VA > 30) PTV40 D0.05 max 110-130 (VA >140 or <110) Koay et al, PRO, 2020 (Rx 50 Gy/5 fx with SIB 33 Gy) iduodenum V40 <0.5cc, V35 < 1cc, V30 <3cc istomach, sm bowel V 40 <0.5cc, V35 <1cc, V30 <2cc liver V12 <50% bile duct max <55 Gy PTV high (50 Gy) covered to 90-95% PTV low (33 Gy) covered to 98% posterior tumor vessels covered to 40 Gy		phase II	AGITG and TROG https://doi.org/10.1016/j.prro.2019.07.018	Koay et al, PRO, 2020 https://doi.org/10.1016/j.prro.2020.01.012
9	Pancreatic Cancer	borderline	borderline	PREOPANC	36 Gy/ 15 fx			1
10	Pancreatic Cancer	borderline	borderline		25 Gy/ 5 fx			expert committee	https://pubmed.ncbi.nlm.nih.gov/18640930/
11	Pancreatic Cancer	borderline	borderline	MDACC	30 Gy/ 10 fx			phase II	https://pubmed.ncbi.nlm.nih.gov/18640930/
12	Pancreatic Cancer	inoperable	inoperable	PRIMUS	45 Gy/ 15 fx			open protocol	https://www.rcr.ac.uk/sites/default/files/pancreatic-cancer-15-fraction-covid19.pdf
13	Pancreatic Cancer	inoperable	inoperable	Int GI guidelines	30-40 Gy/ 5 fx			expert committee
14	Pancreatic Cancer	inoperable	inoperable		omit RT			phase III
15	Esophageal	pre-op	operable	Walsh	40 Gy/ 15 fx			1	https://www.nejm.org/doi/full/10.1056/NEJM199608153350702
16	Esophageal	inoperable	inoperable	RCR	45-50 Gy/ 15 fx			retrospective	https://pubmed.ncbi.nlm.nih.gov/9756167/
17	Esophageal	pre-op	operable	CROSS	41.4-45 Gy/ 23-25 fx		41.4 Gy was evaluated in CROSS, but there is concern that the dose is not sufficient if patient does not proceed to surgery. A dose of 41.1-45 Gy with SIB to 50.4, though not studied specifically on trial, seems rational, especially in 25 fractions.	1	https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00040-6/fulltext
18	Esophageal	pre-op	operable		50.4 Gy SIB			expert committee
19	Esophageal	inoperable, no chemo	inoperable, no chemo	RCR	50-52.5 Gy/ 20 fx			retrospective	https://www.ncbi.nlm.nih.gov/pubmed/30737068
20	Esophageal	inoperable, no chemo	inoperable, no chemo	RCR	50 Gy/ 16 fx			retrospective	https://www.ncbi.nlm.nih.gov/pubmed/30737068
21	Esophageal	inoperable, no chemo	inoperable, no chemo	RCR	55 Gy/ 16 fx			expert committee
22	Esophageal	induction delay	induction chemo	CALGB 80803	delay w induction			phase II	https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.4012
23	Gastric	resectable	no RT		no RT			randomized
24	Cholangiocarcinoma	inoperable	inoperable	MDACC	67.5 Gy/ 15fx			phase II	https://pubmed.ncbi.nlm.nih.gov/26668346/
25	Cholangiocarcinoma	inoperable	inoperable	Rozzano, Italy	30-60/ 3-6 fx			retrospective	https://pubmed.ncbi.nlm.nih.gov/25644863/
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	A	B	C	D	E	F
1		Group	Citation	Description	Link

2	Please contribute by adding your resource! Add to a row at the bottom or comment on a cell
3	Guidelines	ASCO	ASCO, 2020	ASCO's guidelines	https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19
4	Guidelines	ASTRO	ASTRO, 2020	ASTRO's general guidelines	https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information
5	Guidelines	ESTRO	ESTRO, 2020	ESTRO's general guidelines	https://www.estro.org/About/Newsroom/News/Radiotherapy-in-a-time-of-crisis
6	Guidelines	NICE	NICE, 2020	UK NICE's guidelines	https://www.nice.org.uk/guidance/NG162
7	Guidleines	ABS	ABS	ABS guidelines	https://www.americanbrachytherapy.org/about-abs/abs-news/abs-statement-on-coronavirus/
8	Guidelines	CDC	CDC	CDC's latest updates	https://www.cdc.gov/coronavirus/2019-ncov/index.html
9	Guidelines	CDC	CDC	CDC's information for physcians	https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
10	Guidelines	CDC	CDC	CDC secondary links, dashboards, stats	https://www.cdc.gov/library/researchguides/2019novelcoronavirus/datastatistics.html
11	Guidelines	UK guidelines	RCR, 2020	RCR's guidelines for all sites - detailed RT suggestions	https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/coronavirus-covid-19-resources/coronavirus-covid-19-1
12	Guidelines	RANZCR, PeterMac, Victoria Australia	RANZCR	RANZCR, Australia's detailed guideline. All sites included	https://www.ranzcr.com/documents-download/international-medical-graduates/5081-amy-guidelines-to-help-guide-fractionation-schedules-developed-by-peter-maccallum-cancer-care-centre
13	Guidelines	NCCN	NCCN	NCCN site specific guidelines: breast skin prostate Colorectal Cancer Non-Small Cell Lung Cancer T-Cell/Primary Cutaneous Lymphomas	https://www.nccn.org/covid-19/
14	Guidelines	ASTRO-ESTRO	Thomson et al, in press, 2020	ASTRO-ESTRO consensus head and neck guidelines	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf
15	Guidelines	ASTRO-ESTRO	ASTRO-ESTRO	ASTRO-ESTRO consensus lung guidelines	https://www.thegreenjournal.com/article/S0167-8140(20)30182-1/fulltext
16	RT-General	#RadOnc	ctRO, 2020	COVID-19: Global radiation oncology’s targeted response for pandemic preparedness	https://www.sciencedirect.com/science/article/pii/S2405630820300227
17	RT Protocol	Yale	Yale	Yale's internal rad onc COVID19 protocol Observation, delay, modification of RT	https://t.co/bQPWly8eiX?amp=1
18	RT Protocol	Johns Hopkins	Wright et al, Adv Radiat Oncol, 2020	Johns Hopkins' RT protocol	https://www.advancesradonc.org/article/S2452-1094(20)30067-1/fulltext
19	Breast	International	Coles et al, Clin Oncol, 2020	Breast International consensus guidelines during COVID19	https://www.sciencedirect.com/science/article/pii/S0936655520301229
20	Breast	MSKCC	Braunstein et al, in draft	Breast RT: observation, delay, modification of RT	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Braunstein-et-al(ADRO).pdf
21	Prostate	University of Michigan	Zaorsky et al, Adv Radiat Oncol, 2020	Prostate RT: observation, delay, modification of RT	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Zaorsky-et-al(ADRO).pdf
22	Lung	MSKCC	Wu et al, Adv Radiat Oncol, 2020	Lung RT MSKCC	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Wu-et-al(ADRO).pdf
23	Palliation	MSKCC	Yerramilli et al, Adv Radiat Oncol, 2020	Palliation: hypofractionation	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Yerramilli-et-al(ADRO).pdf
24	Rectal	International	Marijnen et al, Radiother Oncol, 2020	Rectal Summary: basically short course with delay for rectal	https://www.thegreenjournal.com/action/showPdf?pii=S0167-8140%2820%2930173-0
25	GI	International	Tchelebi, Radiother Oncol, 2020	International GI guidelines	https://www.thegreenjournal.com/article/S0167-8140(20)30191-2/fulltext
26	RT Protocol	Adv in Rad Onc IJROBP	Adv in Rad Onc IJROBP	All COVID19 articles in Adv Radiat Oncol and IJROBP listed here	https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/Journal-Articles
27	Contouring, dose constraints	econtour	econtour.org	Contouring and dose constraints for hypofx RT regimens - updated for COVID19	econtour.org
28	Transmission, Diagnosis, treatment, infection control	EMCrit	EMCrit, 2020	EMCrit's page on COVID19 (EMCrit is critical care's "wikibook." A wealth of info here)	emcrit.org/ibcc/covid19/
29	RT Protocol	Katz	Katz	Matt Katz' follow-up sheets for COVID19 All sites' NCCN f/u guidelines in one sheet ROS sheets by body site with COVID related questions	https://docs.google.com/spreadsheets/d/1jcHQuV1K5TIlvHdRj5wQM0SLHaRhynYA/edit#gid=1819909582
30	Narrative	Italian RT experience	Filippi et al, IJROBP, 2020	Italy: experiences with triage, suspected positive patients, staff reorganization, reduction of patient traffic in department, hypofractionation	https://www.redjournal.org/article/S0360-3016(20)30930-5/fulltext
31	Narrative	Italian RT experience	Krengli et al, Adv Radiat Oncol	Italy: Reviews patient access, patient support, reorganization of activities, medical physics, academic teaching, lessons learned	https://www.advancesradonc.org/article/S2452-1094(20)30054-3/fulltext
32	Narrative	Seattle RT experience	Din et al, Adv Radiat Oncol, 2020	Seattle: transition to remote work for most of clinic, who to test for COVID19, storage for immobilization devices	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Dinh-et-al-(ADRO).pdf
33	Narrative	Wuhan RT experience	Wu et al, Adv Radiat Oncol, 2020	Wuhan experience	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Han-et-al-(ADRO).pdf
34	Narrative	Taiwan RT experience	Chen et al, Adv Radiat Oncol, 2020		https://www.advancesradonc.org/article/S2452-1094(20)30056-7/fulltext
35	Narrative	COVID on CBCT	Suppli et al, JTO, 2020	COVID19 can be seen on daily CBCT - case report Check CBCTs	https://www.jto.org/article/S1556-0864(20)30299-9/pdf
36	Diagnosis	Case report RSNA	RSNA Mirjana Josipovic	COVID19 related changes can be seen on CBCT prior to symptoms and in asymptomatic patients. Thoroughly check all daily lung CBCTs	https://twitter.com/MirjanaMedPhys/status/1245699770552848385	https://pubs.rsna.org/doi/10.1148/radiol.2020200843
37	Tools	Local healthcare projections	IHME	Check projected hospital resources and peaks in your local area	https://covid19.healthdata.org/
38	Tools	Local healthcare projections	UPenn	Penn's tool to calculate local hospital projections	https://penn-chime.phl.io/
39	General	Lancet articles	Lancet, 2020	All Lancet COVID articles in one location	https://www.thelancet.com/coronavirus
40	General	NEJM articles - open access	NEJM, 2020	All NEJM COVID articles in one location, open access	https://www.nejm.org/coronavirus
41	General	INC	Cancer.gov	(Español) Coronavirus: información para las personas con cáncer	https://www.cancer.gov/espanol/contactenos/emergencia/coronavirus
42	General	Green Journal	Radiotherapy and Oncology, 2020	All Green Journal COVID articles in one location, open access	https://www.sciencedirect.com/journal/radiotherapy-and-oncology/special-issue/1086W2WWCC6
43	Guidelines	ILROG	Blood, 2020	All Blood Journal references in one location, open access	https://www.hematology.org/covid-19
44	Guidelines	ACS	ACS, 2020	American College of Surgeons COVID Surgical Triage Guidelines	https://www.facs.org/covid-19/clinical-guidance/elective-case
45	Guidelines	RCS	RCS, 2020	Royal College of Surgeons (UK) Surgical Triage Guidelines	https://www.rcseng.ac.uk/coronavirus/coronavirus-resources/#vle

	A	B	C	D	E	F	G	H	I	J	K	L	M	N
1	Site	Subtopic	Eligibility	Trial/Group	Dose/fx	Dose constraints	Notes	Link	Link	Link	Link
2	Add your hypofx or alternative treatment regimens being used during COVID19 here. This is a public document open for editing - Please contribute by commenting on a cell or adding a row at the bottom- the editor will then integrate the info
3	General	Treatment interruptions	missed treatments	Washington University	additional fractions for missed treatments	For consideration on adding extra fractions due to an interruption, refer to excellent table in Gay et al, PRO, 2019, describing experiences during Hurricane Maria in Puerto Rico") (links to right) Yale's fantastic protocol (links to right)		https://pubmed.ncbi.nlm.nih.gov/12812848/	https://www.thegreenjournal.com/article/0167-8140(94)90064-7/fulltext
4	CNS	any glioma	curative		30 Gy/6 fx over 2 weeks	Blocks		https://pubmed.ncbi.nlm.nih.gov/6174490/	also GBM citations
5	CNS	any glioma	curative		40 Gy/ 15 fx	Blocks		https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058272/	https://www.ncbi.nlm.nih.gov/pubmed/16757720	https://jamanetwork.com/journals/jama/fullarticle/2536637	Standard -->	same
6	CNS	brain metastasis	brain metastasis		SRS single			https://www.redjournal.org/article/0360-3016(80)90195-9/fulltext	https://www.ncbi.nlm.nih.gov/pubmed/6174490	https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30825-X/fulltext	Standard -->	same
7	Palliation	brain metastasis	palliation	RTOG QUARTZ	20 Gy/ 5 fx			https://www.clinicaloncologyonline.net/article/S0936-6555(05)80717-4/pdf	https://pubmed.ncbi.nlm.nih.gov/6174490/		Standard -->	https://www.ncbi.nlm.nih.gov/pubmed/6174490	https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30825-X/fulltext
8	Palliation	brain metastasis	palliation, poor prognosis	Royal College of Radiologists	12 Gy/ 2 fx	retina, optics, brainstem <100% of dose. Lenses < 4 Gy		https://pubmed.ncbi.nlm.nih.gov/6174490/	also GBM citations		Standard -->	https://www.ncbi.nlm.nih.gov/pubmed/32002556	https://pubmed.ncbi.nlm.nih.gov/11956268/	https://www.ncbi.nlm.nih.gov/pubmed/16168780
9	CNS	LGG	any		40 Gy/ 15 fx			GBM citations			Standard -->	https://www.ncbi.nlm.nih.gov/pubmed/16782910	https://www.ncbi.nlm.nih.gov/pubmed/16782911	https://www.ncbi.nlm.nih.gov/pubmed/19901110
10	CNS	Grade III IDH1 WT	Grade III IDH1 WT		40 Gy/ 15 fx			GBM citations			Standard -->	https://www.ncbi.nlm.nih.gov/pubmed/16782910	https://www.ncbi.nlm.nih.gov/pubmed/16782911	https://www.ncbi.nlm.nih.gov/pubmed/19901110
11	CNS	Grade III IDH1 WT	Grade III IDH1 WT poor PS or elderly		40 Gy/ 15 fx			https://www.ncbi.nlm.nih.gov/pubmed/22877848			Standard -->	https://www.ncbi.nlm.nih.gov/pubmed/16782910	https://www.ncbi.nlm.nih.gov/pubmed/16782911	https://www.ncbi.nlm.nih.gov/pubmed/19901110
12	CNS	Grade III IDH1 WT	Grade III IDH1 WT		34 Gy/ 10 fx			http://ascopubs.org/doi/abs/10.1200/jco.2015.62.6606			Standard -->	https://www.ncbi.nlm.nih.gov/pubmed/16782910	https://www.ncbi.nlm.nih.gov/pubmed/16782911	https://www.ncbi.nlm.nih.gov/pubmed/19901110
13	CNS	Grade III IDH1 WT	Grade III IDH1 WT		25 Gy/ 5 fx			http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.18_suppl.LBA2	https://www.ncbi.nlm.nih.gov/pubmed/15051755	http://ascopubs.org/doi/abs/10.1200/jco.2015.62.6606	https://pubmed.ncbi.nlm.nih.gov/6174490/	Standard -->	https://www.redjournal.org/article/0360-3016(79)90553-4/abstract	https://www.nejm.org/doi/full/10.1056/NEJMoa043330
14	CNS	GBM	any	CCTG/ EORTC/ TROG IAEA	40 Gy/ 15 fx	CTV was 2 cm margin as per EORTC "Whenever possible, without missing the PTV, attempts should be made to limit the biological equivalent dose to the optic nerves, optic chiasm, and retina to less than 40 Gy and brainstem to less than 40 Gy , and avoid that the lens be encompassed by any direct beam."		http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.18_suppl.LBA2	https://www.ncbi.nlm.nih.gov/pubmed/15051755	http://ascopubs.org/doi/abs/10.1200/jco.2015.62.6606	Standard -->	http://ascopubs.org/doi/abs/10.1200/jco.2015.62.6606	https://www.ncbi.nlm.nih.gov/pubmed/22877848	https://www.ncbi.nlm.nih.gov/pubmed/15051755
15	CNS	GBM	age ≥65 OR KPS<70	CCTG/ EORTC/ TROG IAEA	40 Gy/ 15 fx			https://pubmed.ncbi.nlm.nih.gov/22877848/			Standard -->	http://ascopubs.org/doi/abs/10.1200/jco.2015.62.6606	https://www.ncbi.nlm.nih.gov/pubmed/22877848	https://www.ncbi.nlm.nih.gov/pubmed/15051755
16	CNS	GBM	age ≥60 OR poor KPS	Linköping University, Sweden	34 Gy/ 10 fx			https://www.redjournal.org/article/S0360-3016(02)04522-4/fulltext			Standard -->	https://www.redjournal.org/article/0360-3016(79)90553-4/abstract	https://www.nejm.org/doi/full/10.1056/NEJMoa043330
17	CNS	GBM	age < 65		50 Gy/ 20 fx			http://ascopubs.org/doi/abs/10.1200/jco.2015.62.6606			Standard -->	http://ascopubs.org/doi/abs/10.1200/jco.2015.62.6606	https://www.ncbi.nlm.nih.gov/pubmed/22877848	https://www.ncbi.nlm.nih.gov/pubmed/15051755
18	CNS	GBM frail	age ≥50, KPS 50-70, or age ≥65 KPS 50-100	IAEA	25 Gy/ 5 fx			https://pubmed.ncbi.nlm.nih.gov/31718650/	https://aapm.onlinelibrary.wiley.com/doi/full/10.1118/1.3438081			https://academic.oup.com/neurosurgery/article-abstract/70/1/32/2744161?redirectedFrom=fulltext	https://academic.oup.com/neurosurgery/article-abstract/62/1/53/2558403?redirectedFrom=fulltext
19	CNS	Meningioma	grade 1-2	Italy Germany	25 Gy/ 5 fx		Five hundred patients were recruited, but data on symptomatic improvement at 3 months was only available on 272 patients. Of these, 68% achieved symptomatic improvement (71% for 35 Gy, 64% for 21 Gy), with no evidence of a difference in efficacy or toxicity between the two arms. There was no evidence of a difference in survival between the two schedules (hazard ratio [HR] = 0.99, 95% CI 0.82-1.21, p = 0. 933).	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135793/
20	CNS	Meningioma	unresected or recurrent		36 Gy/ 9 fx		The treatment was well tolerated. Seventy-seven percent of patients had a significant reduction or stabilization of their disease following treatment, and 44% of the evaluated patients showed improved QOL	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135793/	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495433/
21	CNS	Meningioma	unresected or recurrent		24 Gy/ 3 fx			https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135793/	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495433/
22	CNS	Meningioma	unresected or recurrent		21 Gy/ 3 fx		same efficacy as longer schemes, 5x4 Gy and 10x3Gy	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135793/	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255720/	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495433/	https://www.frontiersin.org/articles/10.3389/fonc.2013.00213/full
23	CNS	Meningioma	unresected or recurrent		30 Gy/ 5 fx		Debatable. Mentioned in Peter MacCallum's response plan for lung (March 2020) and suggested by D Palma especially when surgery being limited. May be delayed or omitted if systemic treatments available (? e.g. ADT for prostate mets). Limited evidence for OS.	https://twitter.com/drdavidpalma/status/1243595381084225538	https://www.ranzcr.com/documents-download/international-medical-graduates/5081-amy-guidelines-to-help-guide-fractionation-schedules-developed-by-peter-maccallum-cancer-care-centre
24
25
26
27
28
29
30
31
32

	A	B	C	D	E	F	G	H	I	K	L
1	Site	Subtopic	Eligibility	Trial/Group	Dose/fx	Dose constraints	Notes	Evidence	Link	Link	Link

2	Head and neck	Definitive Hypofx	locally advanced	RCR Brazil	55 Gy/ 20 fx	BED calculations	The ASTRO-ESTRO panel had strong agreement that 2.41-3.0 Gy per fraction was acceptable during late pandemic phases. Concurrent chemo was recommended in mild hypofractionation of ≤2.4 Gy per fraction.	phase II	http://www.ccsenet.org/journal/index.php/cco/article/view/37087	https://bmccancer.biomedcentral.com/track/pdf/10.1186/s12885-018-4893-5	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf
3	Head and neck	Post-op Hypofx	locally advanced	RCR Brazil	50-5 Gy/ 20-22 fx	BED calculations		extrapolation from definitive	http://www.ccsenet.org/journal/index.php/cco/article/view/37087	https://bmccancer.biomedcentral.com/track/pdf/10.1186/s12885-018-4893-5
4	Head and neck	Definitive Hypofx	locally advanced	Brazil	54 Gy/ 18 fx	BED calculations		retrospective	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf	https://www.ncbi.nlm.nih.gov/pubmed/19475548	https://www.ncbi.nlm.nih.gov/pubmed/25379320
5	Head and neck	Definitive Hypofx	oral cavity post op	Korea	50 Gy/ 20 fx	BED calculations		retrospective	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf	https://www.e-roj.org/m/journal/view.php?number=1432
6	Head and neck	Definitive Hypofx	locally advanced	ASTRO-ESTRO guidelines	62.5-64 Gy/ 25 fx	BED calculations	The ASTRO-ESTRO panel had strong agreement that 2.41-3.0 Gy per fraction was acceptable during late pandemic phases. Concurrent chemo was recommended in mild hypofractionation of ≤2.4 Gy per fraction.	phase II	https://pubmed.ncbi.nlm.nih.gov/29478732/	https://pubmed.ncbi.nlm.nih.gov/25279959/	https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf
7	Head and neck	Definitive HPV+	localized HPV+	NRG HN-002	60 Gy/ 30 fx	Conventional	Consider planning first to 70 Gy, then at time of 60 Gy consider end of treatment based on status of patient, clinical response, and viral status in your community. Alternatively, if a patient has tested positive, ending at 60 Gy may be prudent.	phase II	https://www.redjournal.org/article/S0360-3016%2819%2933673-9/fulltext
8	Head and neck	post-op ENE	ENE post-op	MDACC	60-63 Gy for HPV- 60 Gy for HPV+	Conventional	60 Gy may also be appropriate for any extent of ENE in HPV+ based on NRG HN002. In the MDACC dose escalation study, small foci of ENE were allowed in the 60 Gy group.	1	https://www.redjournal.org/article/S0360-3016(17)30633-8/abstract
9	Head and neck	Definitive, no chemo	nonchemo, eligible for curative RT	DAHANCA	66 Gy/ 33 fx, 6 per week	BED calculations	Although not extremely shortened, this regimen does offer an incremental shortening over 35 treatments.	1	https://www.ncbi.nlm.nih.gov/pubmed/14511925	https://www.ncbi.nlm.nih.gov/pubmed/26255764
10	Head and neck	Definitive, no chemo	nonchemo, eligible for curative RT	RTOG 0022	66 Gy/ 30 fx daily	Conventional		Phase II	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846217/pdf/nihms113223.pdf
11	Head and neck	Definitive, split course	any	Split course Duke Intergroup	70 Gy, 2 week break at 40 Gy	Conventional	Although proven inferior to conventional fractionation in trials, split course could prove useful in truly emergent situations, such as with a patient who is COVID+, high local prevalence, or severely reduced staffing and resources. Favor continuing treatment per standard fractionation with PPE if feasible in your department.		https://www.nejm.org/doi/full/10.1056/NEJM199806183382503	https://www.nejm.org/doi/full/10.1056/NEJM199806183382503
12	Head and neck	Reduced volume	any	ACRIN 6685 Washington U	omit neck in PET -ve and/or pN0 neck omit post-op tonsil bed if no indication to tx		To optimize performance status, especially out of concern that COVID infection could occur at any time, consideration should be given to reduce volume as much as possible. ACRIN showed a 94% NPV in PET negative necks before dissection. Wash U's study showed high LC when RT was omitted to a dissected neck that was pN0. In the AVOID trial, omission of RT to the tonsil post-op bed was safe if there were indications to treat the neck but not the post-op bed.	phase II	https://pubmed.ncbi.nlm.nih.gov/31785337/
13	Head and neck	surgery	resectable tumors	-	omission of surgery		If there are already factors present to mandate adjuvant RT, then the patient should proceed to definitive RT or chemo RT and surgery avoided, especially for HPV+ tumors.
14	Head and neck	induction chemo	n/a	ASTRO-ESTRO	induction chemo (not recommended)				https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf
15	Head and Neck	Hypofx	Glottic T1	Royal Marsden	50-52.5 Gy in 15-16 fx	BED calculations	b	Retrospective	https://www.ncbi.nlm.nih.gov/pubmed/12972304	https://www.ncbi.nlm.nih.gov/pubmed/19375900
16	Head and Neck	Hypofx	Glottic T2	Royal Marsden	55 Gy in 20 fx	BED calculations	0	Retrospective	https://www.ncbi.nlm.nih.gov/pubmed/16635034	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580345/
17	Skin	Post-op Hypofx	locally advanced	RANZCR	50-5 Gy/ 20-22 fx	BED calculations		extrapolation from definitive	http://www.ccsenet.org/journal/index.php/cco/article/view/37087
18	Skin	HDR	HDR		20 Gy/ 5 fx daily
19	Skin	Merkel	hypofx	NCCN	8-24 Gy/1-3 fx				https://www.nccn.org/covid-19/pdf/NCCN-NMSC-Ref2.pdf	https://www.nccn.org/covid-19/pdf/NCCN-NMSC-Ref1.pdf
20	Skin	SCC, MCca, Rare	SCC, MCca, Rare	RCR	32.5 Gy/ 4 fx
21	Skin	SCC, MCca, Rare	SCC, MCca, Rare	RCR	40 Gy/ 8 fx
22	Skin	SCC, MCca, Rare	SCC, MCca, Rare	RCR	50 Gy/ 15 fx	BED calculations

	A	B	C	D	E	F	G	H	I	J	K	L	M
1	Site	Subtopic	Eligibility	Trial/Group	Dose/fx	Dose constraints	Notes	Link	Link	Link	Link

2	NSCLC locally advanced	RT seq/concurrent	locally advanced	UK SOCCAR	55 Gy/ 20 fx	"Consider BED calcs. 55 Gy/ 20 fx: From the original protocol: lung V20 <30%, include < 12 cm esophagus, cord max <44 Gy"	On the ASTRO-ESTRO panel, 73% did not advise hypofractionation with chemo. Of those that did, these regimens were most commonly suggested.	https://www.ejcancer.com/article/S0959-8049(14)00809-0/fulltext	https://pubmed.ncbi.nlm.nih.gov/17084621/
3	NSCLC locally advanced+	RT alone or sequential	locally advanced	UK SOCCAR	55 Gy/ 20 fx	"Consider BED calcs. 55 Gy/ 20 fx: From the original protocol: lung V20 <30%, include < 12 cm esophagus, cord max <44 Gy"		https://www.ncbi.nlm.nih.gov/pubmed/24094626
4	Ü	RT alone or sequential	locally advanced		50-60 Gy/ 15 fx			https://pubmed.ncbi.nlm.nih.gov/26987393/	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123185/
5	0Ü	sequential	locally advanced		50 Gy/ 20 fx			https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30180-9/fulltext
6	0Ü	RT alone or sequential	locally advanced	ASTRO-ESTRO	60-66 Gy/ 24-30 fx						https://pubmed.ncbi.nlm.nih.gov/17084621/	https://www.redjournal.org/article/S0360-3016(16)32089-2/abstract	https://pubmed.ncbi.nlm.nih.gov/23182393/
7	0	RT alone or sequential	locally advanced	MDACC UTSW	60 Gy/ 15 fx			https://pubmed.ncbi.nlm.nih.gov/26279026/
8	NSCLC locally advanced	RT alone or sequential	locally advanced	MDACC	45 Gy/ 15 fx			https://www.ncbi.nlm.nih.gov/pubmed/25957184
9	NSCLC locally advanced	RT alone or sequential	locally advanced		40 Gy/ 15 fx
10	NSCLC locally advanced	RT alone or sequential	locally advanced	Rome, Italy	60 Gy/ 18-20 fx
11	NSCLC SBRT	SBRT single fx	T1-T2 peripheral	NSCLC SBRT	30 or 34 Gy/ 1 fx	Spinal Cord V10 < 0.35cc, V7 < 1.2cc, Dmax 14 Gy Esophagus V11.9 < 5 cc , Dmax 15.4 Gy Brachial Plexus V14 < 3cc, Dmax 17.5 Gy Heart/Pericardium V16 < 15cc, Dmax 22 Gy Great Vessels V31 < 10cc, Dmax 37 Gy Trachea/large bronchi V10.5 < 4cc, Dmax 20.2 Gy Rib V22 < 1cc, Dmax 30 Gy Lung (L&R) for basic function: V7 < 1500cc Lung (L&R) for pneumonitis: V7.4 <1000cc		https://www.ncbi.nlm.nih.gov/pubmed/30513377	https://www.redjournal.org/article/S0360-3016(19)33653-3/fulltext
12	NSCLC SBRT	SBRT single fx	T1-T2 peripheral	NSCLC SBRT	25 to <30 Gy/ 1 fx			https://www.redjournal.org/article/S0360-3016(11)03479-1/abstract
13	NSCLC SBRT	SBRT single fx	T1-T2 peripheral	NSCLC SBRT	54 Gy (or 60 Gy)/ 3 fx			https://www.redjournal.org/article/S0360-3016(19)33653-3/fulltext
14	NSCLC SBRT	SBRT single fx	T1-T2 peripheral		45 Gy/ 3 fx			https://www.ncbi.nlm.nih.gov/pubmed/19556022/
15	NSCLC SBRT	SBRT single fx	T1-T2 peripheral	NSCLC SBRT	48 Gy/ 4 fx
16	NSCLC SBRT	SBRT single fx	T1-T2 peripheral	NSCLC SBRT	50 Gy/ 4 fx
17	NSCLC SBRT	SBRT single fx	T1-T2 central	NSCLC SBRT	50 Gy/ 5 fx
18	NSCLC SBRT	SBRT single fx	T1-T2 central	NSCLC SBRT	50-55 Gy/ 5 fx
19	NSCLC SBRT	SBRT single fx	central/ultracentral		70 Gy/ 10 fx
20	NSCLC SBRT	SBRT ultracentral	ultracentral	MSKCC	60 Gy/ 8 fx
21	NSCLC locally advanced	post-op	N2	NCCN	50-60 Gy/ 15-20 fx
22	SCLC limited	SABR	T1-T2 not candidates for surgery		SABR
23	SCLC limited	hypofx daily	Limited	Norway Canada Belgium	40-45 Gy/ 15-16 fx qd	Lung V20 ≤ 30% lung mean < 20 Gy Esophagus dmax < 105%		https://www.clinical-lung-cancer.com/article/S1525-7304(14)00244-7/fulltext	https://www.sciencedirect.com/science/article/abs/pii/S1278321817300380	https://www.sciencedirect.com/science/article/pii/S0923753419401804
24	SCLC extensive	chest consolidation	extensive	RANZCR	20 Gy/ 5 fx
25	Lung	Palliation	lung	IAEA	8 Gy x 1 10 Gy x 1			https://www.redjournal.org/article/S0360-3016(17)31296-8/fulltext
26	Lung	Palliation	lung	MRC	16-17 Gy/ 2 fx weekly			https://www.redjournal.org/article/S0360-3016(17)31296-8/fulltext	https://pubmed.ncbi.nlm.nih.gov/15770205/	https://pubmed.ncbi.nlm.nih.gov/14990635/
27	Lung	Palliation	lung SVC	Poland	20 Gy/ 5 fx
28	Lung	Palliation	lung		8-12 Gy/ 1 fx
29	Lung	Palliation	lung		20-30 Gy/ 5 fx
30	Lung	Palliation	lung		30-40 Gy/ 10 fx
31	Lung	Palliation	lung		27 Gy/ 6 fx

	A	B	C	D	E	F	G	H	I	J	K	L	M
1	Site	Subtopic	Eligibility	Trial/Group	Dose/fx	Dose constraints	Notes	Evidence	Link	Link	Link	Link

2	Breast	early stage, PBI Florence	ASTRO PBI criteria	University of Florence	30 Gy/ 5 fx qod	IMRT was used. Consider also 3DCRT PTV V28.5 = 100% PTV max < 105% (31.5 Gy) PTV min 28 Gy uninvolved breast V15< 50% ipsilateral lung V10< 20% contralateral lung V5< 10% heart V3< 10%		1 - equivalent, possibly superior to WBRT	https://doi.org/10.1016/j.ejca.2014.12.013	https://www.abstractsonline.com/pp8/#!/7946/presentation/1921	https://www.ncbi.nlm.nih.gov/pubmed/27478165
3	Breast	early stage, PBI EBRT	ASTRO PBI criteria	RAPID	38.5 Gy/ 10 fx BID	RAPID ipsi lung V30% < 10% heart, right V5% < 5% heart, left outside LIQ V10% < 5% heart, LIQ, V15% < 5% contra lung V5% < 5% thyroid and contra breast max <3%		meta-analysis	https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32514-0/fulltext	https://www.ncbi.nlm.nih.gov/pubmed/27478165
4	Breast	early stage, PBI EBRT	ASTRO PBI criteria	MSKCC	40 Gy/ 10 fx daily			prospective	https://pubmed.ncbi.nlm.nih.gov/30851350/
5	Breast	early stage, PBI EBRT	ASTRO PBI criteria	UK IMPORT LOW	45 Gy/15 fx daily			phase III
6	Breast	early stage, PBI IORT	ASTRO PBI criteria	TARGIT	20 Gy/ 1 fx IORT	IORT "Radiation is delivered over 20–45 min to the tumour bed. The surface of the tumour bed typically receives 20 Gy that attenuates to 5–7 Gy at 1 cm depth"		meta-analysis	https://www.ncbi.nlm.nih.gov/pubmed/24224997/	https://www.ncbi.nlm.nih.gov/pubmed/27478165
7	Breast	early stage, PBI HDR	ASTRO PBI criteria	GEC-ESTRO	32 Gy/8 fx BID 30.3 Gy/ 7 fx BID	Implant VPD ≤ 300 cm3, DNR ≤ 0.35 PTV V100 ≥ 90%, V150<65cm3, V200<15cm3, COIN ≥ 0.65 uninvoled breast V90< 10%, V50< 40% Skin D1cm3< 90%, D0.2cm3< 100% Rib D0.1cm3< 90%, D1cm3< 80% Heart mean < 8%, D0.1cm3< 50% Ipsi lung mean < 8%, D0.1cm3< 60%		1 - noninferior, possibly superior to WBRT	https://www.ncbi.nlm.nih.gov/pubmed/26494415	https://www.thegreenjournal.com/article/S0167-8140(18)30197-X/fulltext
8	Breast	early stage, WBRT	WBRT	UK FAST	28.5 Gy/ 5 fx once weekly	(In FAST, RT was 2D and dose constraints were limitations of cm of heart in field) Dose constraints in FAST FORWARD (open protocol) heart V1.5< 30%, V7< 5% ipsilateral lung V8< 15%		meta-analysis	https://www.thegreenjournal.com/article/S0167-8140(11)00337-9/fulltext	https://www.astro.org/ASTRO/media/ASTRO/Meetings%20and%20Education/PDFs/AM18/LBA18.pdf	https://www.eventscribe.com/2018/ASTRO/fsPopup.asp?Mode=presInfo&PresentationID=449634	https://www.ncbi.nlm.nih.gov/pubmed/27478165	https://d1ijoxngr27nfi.cloudfront.net/docs/default-source/default-document-library/fast-forward-protocol.pdf?sfvrsn=421a2169_0
9	Breast	Early stage >50's	WBRT	UK FAST FORWARD	26Gy / 5 fx daily	Dose constraints in FAST FORWARD heart V1.5< 30%, V7< 5% ipsilateral lung V8< 15%		phase III	https://www.icr.ac.uk/our-research/centres-and-collaborations/centres-at-the-icr/clinical-trials-and-statistics-unit/clinical-trials/fast_forward_page/	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998960/	Brunt et al (FAST-Forward). Lancet. April 2020.
10	Breast	Node positive	WBRT	UK FAST FORWARD	26Gy / 5 fx daily	Dose constraints in FAST FORWARD heart V1.5< 30%, V7< 5% ipsilateral lung V8< 15%		phase III	https://www.icr.ac.uk/our-research/centres-and-collaborations/centres-at-the-icr/clinical-trials-and-statistics-unit/clinical-trials/fast_forward_page/	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998960/	Brunt et al (FAST-Forward). Lancet. April 2020.
11	Breast	early stage, WBRT	WBRT	START A/B	40-42.5 Gy/15-16 fx
12	Breast	fungating	fungating	RANZCR	36 Gy/ 8 fx, 2-3 per week			expert committee
13	Breast	early stage, WBRT	WBRT	RANZCR	36 Gy/ 8 fx, 2-3 per week			expert committee
14	Breast	early stage, boost	early stage, boost planned	Humanitas Research Hospital and Cancer Center, Milan, Italy SKAGEN DBCG HYPO II RTOG 1005	omit boost, or consider VMAT SIB 40 & 45.75/15 fx 42.3 & 52.2/18 fx 40-40.5 & 48/15 fx	Conventional dose constraints. The first two doses are from open protocol DBCG HYPO II. The third dose is from the completed phase II Milan study and also RTOG 1005.		phase II	https://pubmed.ncbi.nlm.nih.gov/30149235/	https://www.dbcg.dk/PDF%20Filer/SKAGEN%20Trial%201_%20protokol.pdf	https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwiA9OT606LoAhUISK0KHYo6CkcQFjAAegQIBRAB&url=https%3A%2F%2Fwww.rtog.org%2FClinicalTrials%2FProtocolTable%2FStudyDetails.aspx%3Faction%3DopenFile%26FileID%3D9366&usg=AOvVaw2eE11ewjRLyzFLHEFrEXCG
15	Breast	PMRT	without implants (consider with)	Fourth Military Medical University, Xi'an, China	40-43.5 Gy/15 fx			phase III	https://www.ncbi.nlm.nih.gov/pubmed/30711522	https://www.redjournal.org/article/S0360-3016(20)30883-X/fulltext
16	Breast	PMRT	with implants	RT CHARM	40-43.5 Gy/15 fx			extrapolation
17	Breast	WBRT	boost	Korea	9 Gy/ 3 fx			phase II	https://pubmed.ncbi.nlm.nih.gov/24267970/
18	Breast	WBRT/PMRT	boost		omit boost			1	https://www.ncbi.nlm.nih.gov/pubmed/31055108
19	Breast	PMRT	PMRT	various	omit bolus?			retrospective (both for and against)	https://pubmed.ncbi.nlm.nih.gov/28395915/	https://pubmed.ncbi.nlm.nih.gov/29580696/	https://pubmed.ncbi.nlm.nih.gov/30926576/
20	Breast	WBRT	ER+		delay up to 20 weeks
21	Breast	WBRT	Elderly 65-70	PRIME CALGB	omit RT			1
22	Breast	WBRT	genomic profile low risk	SWOG	omit RT			retrospective	https://jamanetwork.com/journals/jamaoncology/article-abstract/2758265
23	Breast	RNI	T1, ER+, Her2-, grade 1-2, 1-2 nodes	various	omit RT			retrospective	https://www.sciencedirect.com/science/article/pii/S0936655517302984/pdfft?md5=3bf3ff6cb2812707db54c3ffa328b7e5&pid=1-s2.0-S0936655517302984-main.pdf	https://jamanetwork.com/journals/jamaoncology/article-abstract/2758265	https://www.ncbi.nlm.nih.gov/pubmed/15817335	https://www.ncbi.nlm.nih.gov/pubmed/30419307	https://www.ncbi.nlm.nih.gov/pubmed/10561205
24	Breast	DCIS	DCIS	EBCTCG	omit RT			phase III
25	Breast	Elderly (>65-70yo)	WBRT/Chest wall/RNI	Hospital del Mar, Parc de Salut Mar, Barcelona, Spain	30-37.5 Gy/6 fx once weekly			Observational, prospective	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875042/pdf/BMRI2018-8321871.pdf
26	Breast	pre-op WBRT	WBRT	UK FAST FORWARD based	26Gy / 5 fx daily	Dose constraints in FAST FORWARD (open protocol) heart V1.5< 30%, V7< 5% ipsilateral lung V8< 15%		expert committee
27	Breast	pre-op N+	N+	UK FAST FORWARD based	26Gy / 5 fx daily	Dose constraints in FAST FORWARD (open protocol) heart V1.5< 30%, V7< 5% ipsilateral lung V8< 15%		expert committee