Non-malignant Disease   

Would you treat just the gross tumor at recurrence or the entire initial operative bed? Do your volumes and dose differ from those treated adjuvantly ...

In young adults (20-30), would you provide perioperative radiotherapy f if they have actually developed HO?

Tumor factors: Neck mass, 6 cm in length, biopsy proven schwannoma. No extension into base of skull Patient factors: No dysphagia, no dysphonia i.e. ...

Does the time interval between the intial RT and recurrence influence your decision? What time interval would you feel is appropriate? What dose would...

It's been 5+ years after the first course. If you decide to re-irradiate what dosing schema would you use?

What dose and field margins would you add? Is a 50% response rate realistic to counsel a patient? What would you quote as a realistic rate for seconda...

If, yes, what dose and fraction size did you use?

Main concern is radiation induced thyroid cancer

Assouline et al., PMID 24411632 recommend delivering 500cGy x 4 fractions = 2000cGy on days 1, 3, 8, 10. Do you follow this schedule, treat every othe...

 If not, then what is your preferred treatment and would you integrate SRS into it? 

Have a patient with a multi-year history of a growing substernal goiter. There is mass effect on the trachea, esophagus, and aorta. He is experiencing...

If a patient has been treated sucessfully for Graves but has persistent symptoms of diplopia, is radiation therapy helpful? Or is this just a dry and ...

Does this affect your subsequent imaging surveillance frequency?

What dose/fractionation regimen is most appropriate?  -i.e. 12 Gy in 4 fractions, but would you modify that approach in a young patient? What i...

If so, what patients do you recommend get one and do you have concerns for patients who also may be receiving chemotherapy as the CDC guidelines recom...

Would you offer SBRT for a functional adrenal adenoma (Cushings)? If so, what dose would you deliver and what are some contouring and planning pearls?

Do you have any reservations about the efficacy of SRS over surgery?

For example, meningiomas or pituitary adenomas?

Assume there are high risk factors such as recurrence or positive margins. 

Often physicians must choose between treatment with surgery or SRS. What patient factors would drive one to choose surgery or SRS?

With the publication of the ARUBA trail results, should management of AVMs shift toward medical management?  

What constraints do you use for plan evaluation?

If so, what would be your recommended technique/dose?

Will this disappear over time on its own or should I be concerned that the necrosis will worsen over time, and repeat MRI more frequently?

I treat early-stage nodularity and cording, but am not sure whether to treat knuckle pads.

For example, if a patient had a very infiltrating lipoma or one that is compressing critical structures, would you offer RT?  If so, what would b...

How do you sequence imaging and headframe placement? Do you fuse a 3D CTA to the planning CT?

Do you just contour all the visible breast density? If you wire what's palpable (which is a bit subjective), do you include everything within the wire...

SPCG-07 (Widmark et al) and a large Norwegian registry study (Aksnessæther BY IJROBP 2018) use 12-15Gy/1fx with electrons, but others use 3...

Would you treat Dupuytren’s contracture shortly after surgery or wait till patient develops new contracture? What dose and fractionation do you ...

Dependent upon histology, when would you offer RT to an asymptomatic patient who refuses consideration of any future surgical intervention?

How long do you advise them to refrain from unprotected sex following RT? I was trained to discuss these issues with patients but the gonada...

Would you use adjuvant radiotherapy after xiaflex injection or needle aponeurotomy?

Classical teaching is the sooner the better - but there are times that treatment gets delayed or adjustments need to be made after seeing the post-op ...

What dose/fractionation would yield the lowest risk of graft failure? Does your treatment management change based of location, ex the ear vs back?

For patients who are not candidates for excision, have you effectively used radiation alone? There is a study using 7.5 Gy x5 in weekly doses (Malaker...

Do you routinely offer re-irradiation? If so, what is your preferred dose and technique?

A retrospective review of the use of adjuvant radiation in the recurrent setting for pleomorphic adenoma of the parotid gland reported a 20 year actua...

If the patient had RT 3 months prior and had a revision surgery, would you offer RT again? If so, which dose and fractionation would you use?

Every physician and institution seems to take a different approach based on factors such as type of replacement and whether or not cement was used.&nb...

What is your approach to deciding when to treat these patients? Or is it solely dependent on when surgeons refer them?

The literature does not seem to report on the rates of improvement of headaches.

And does your dose changes with positive margins? I can't seem to find a good answer in the literature.