How would you plan sequencing of an MRI-directed prostate nodule micro-boost when doing a sequential plan?

Some reports do profile the use of a sequential tumor boost (e.g., Miralbell et al., PMID 19910135); however, I would usually not recommend this unless a brachytherapy boost is planned. Although I could think of a few niche circumstances where there could be a rationale for a sequential boost (SEQ),...

I only use simultaneous integrated boost, as was done in FLAME. I cannot think of a good reason to deviate from that and have not yet encountered one.

@Dr. First Last had nicely listed reasons SIB is preferred.

SIB would also lessen the effects of accelerated repopulation that would, in theory, be seen with the increased time necessary for a sequential boost, assuming you're concerned about that with a micronodule boost for prostate cancer.

On the urethral constraint, I don't see any need for one if you ar...

1. I would follow the current expert literature
2. Follow expert recommendations