You can use the ESC calculator to explore alternative methods of delivering missing BED, such as by fewer fractions, BID, concomitant, or brachytherapy. For example, using the case above, lets say you want to makeup for the 800 cGy deficit that resulted from the patient missing 4 treatments, but the patient is leaving on vacation and there are only 3 days available. In the ESC window, uncheck the Match IMR BED box and enter a Target BED of 9.60. Set the number of ESC fractions to 3. The result of 765 cGy delivered in 3 fractions of 255 cGy will deliver the required BED of 9.6 Gy(10.0)
Another option is to mark missed treatment days on the course calendar (select course #1 and shift-click on the missed dates). The "Auto Sequence Courses" button in the Course Calendar window will automatically reconfigure all included IMR courses and display the updated BED. To get the most benefit from this calculation tumor repopulation should be included in the calculation. You can explore the biological effect of additional fractions to compensate for tumor repopulation by enabling repopulation in the biology group.
