What dosimetric considerations, if any, do you have when treating a lateral dominant intraprostatic lesion adjacent to the levator ani with simultaneous integrated boost?

I am not aware of any data directly evaluating the effect of elevator ani dose on GI toxicity/ QoL in patients undergoing prostate RT with intraprostatic boost. There have been prior studies on this topic in the prostate cancer population receiving homogeneous dosing, however. For example, Schaake a...

There are no accepted dose constraints for the levator ani. I would try to minimize high-dose spill into the levator ani. Also, keep hotspots intraprostatic with a steep dose gradient.

I do not use any, beyond generally trying to avoid high doses beyond the target. There is a reasonable hypothesis regarding dose-response to the pelvic floor, but what we know currently is that focal boost was very well tolerated on FLAME (and several other single-arm studies). I would not trade kno...