For gyn cancers receiving chemoradiation, how high can you boost grossly positive nodes with SIB if not near bowel?

I typically will give a simultaneous integrated boost (SIB) of 60 Gy in 30 fractions to the pelvic and para-aortic nodal CTV, which is the PET positive GTV plus a 3 mm margin. If possible I will boost the GTV of larger gross nodes (>1 cm) to 66 Gy (2.2 Gy/fx) with no margin, if constraints can be me...

I have not attempted to push the dose further than it is written in EMBRACE II. Keep in mind that this is at a higher dose per fractionation (as high as 2.3Gy per fraction) than we typically use. Assuming an alpha/beta of 10 for SCC this calculates to a BED ~ 58Gy for the diseased node, but a higher...

EQ2 calculation doesn’t take time factor into account and also contributions from brachytherapy for pelvic nodes.

I will usually go for 55-60 Gy in 25 fractions based on location with 45 in 25 to the remainder of elective nodal regions. GTV + 5mm to PTV. Goal is to keep the treatment isotoxic, however, so will turn down the dose at interface of bowel, always, and bladder/rectum as necessary.

While Dr. @Dr. Firs...