If a patient is noted to have multiple PIRADS-4 and PIRAD-5 lesions of the prostate on MRI, do you offer simultaneous integrated boost via FLAME?

If so, how do you determine which of the lesions constitutes the "dominant" lesion to boost?

Alternatively, do you treat all noted lesions with SIB, or do you avoid SIB altogether in this case where a dominant intraprostatic lesion is not easily identifiable?

Answer from: Radiation Oncologist at Academic Institution

It is a reasonable approach to boost multiple lesions. The FLAME protocol allowed for the treatment of multiple GTVs as long as dose constraints could be maintained. These investigators published a separate paper evaluating the contouring on the trial and reported a maximum of 5 lesions boosted in a...

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Radiation Oncologist at CommonSpirit
Outstanding response. My practice is similar, also...

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If a patient is noted to have multiple PIRADS-4 and PIRAD-5 lesions of the prostate on MRI, do you offer simultaneous integrated boost via FLAME?

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