What is the maximum dose to small bowel you would allow in a single fraction with gynecologic brachytherapy?

There is no absolute number, but for a 5 fraction HDR schedule (5.5-6Gy x 5), we limit 2cc to less than 3 Gy and have accepted up to 4 Gy. We make sure that there is no hot spot touching small bowel loop by varying the filling of the bladder and sometimes using a hybrid applicator if needed to try t...

I strive to keep my D2cc of the sigmoid/rectum to less than 70Gy. The largest dataset we have is from the prospective EMBRACE study with 960 pts with a follow up of 25.4 months. In this study, having a D2cc of less than or equal to 70Gy had a 10% risk of grade 2 or greater toxicity. A D2cc of > or e...