When treating with chemo/RT for bladder cancer, how concerned are you with small bowel dose constraints when boosting the bladder to 60 Gy?

This is an excellent question, and something we struggle with. DVH parameters are important considerations, but I also feel that sometimes we put too much emphasis on dose contraints; as if the sky will fall if you pass a threshold. Exceeding a parameter is no guarantee of good or bad outcome, but m...