Case 1:
63 yo Anal T3
Large LN adjacent to tumor
small bowel toxicity of full dose tradeoffs vs. sparing
Dose Constraints not an all or none option
Nodes conedown/boost
Highest does first course
Questioning of RTOG-2509

Case 2:
75 yo Multifocal Esophagus (3 masses plus LNs)
masses at cervical, mid, and large cardia
Folfox x 4 had partial response on PET for LNs, but not primary
Not a surgical candidate
Toxicity benefit of 3 separate fields
Mucosal spread
Herskovic Trial
Heart dose

Case 3:
55 yo Rectal adenocarcinoma with inguinal and iliac nodal involvement.
Lung nodules on PET,but low SUV
Chronic seizure disorder.
Surgeon declines lung biopsy
Course goal: palliative vs definitive; short vs. long course