Does anticoagulation alter your decision for elective nodal radiation in a prostate cancer patient?

The short answer is no. I have not seen strong evidence that anticoagulants increase the risk of GI toxicity. However, if bleeding develops, it may be more difficult to manage. The source of bleeding is generally in the anterior rectal wall, as it is with patients not on anticoagulants. Thus, I tend to use more restrictive rectal dose constraints, especially if the patient requires lifelong anticoagulation. I’ll aim for a V70 <10% for conventional fractionation or its equivalent for a hypofracti...