It’s peanut butter jelly time.

Effective whole brain radiation (WBRT) can be achieved with little more set-up concerns than boney alignment. But in the era of 3D image-guidance, can we do better? This observational study of 73 patients receiving conventional WBRT at UNC and affiliate sites reports “clinically significant” treatment-related xerostomia in over one-third of patients at one month, defined as an increase of ≥20 points on a validated patient scale. What’s more, upon post-hoc dosimetric analysis, xerostomia was clearly associated with increasing mean parotid dose in a continuous fashion. Volumetrically speaking, the median parotid volume receiving at least 20 Gy was 47%. Among those with at least this median V20, half were bothered by xerostomia at least “quite a bit” at 3 months compared to none with a lower V20. TBL: Just a wee bit tighter MLCs around the mandibular condyle (check out figure 3) could make or break your patient’s ability to enjoy a lunchtime PBJ. | Wang, JAMA Oncol 2018