Radiation Oncology   

Questions discussed in this category


For instance, should post-operative radiation therapy be offered a patient with a 4 cm malar SCCA, resected with negative margins, no PNI, and a compl...

The recently published executive summary from ASTRO/ASCO/AUA hypofractionated radiation therapy for localized prostate cancer states "Five-fracti...

Is a detectable PSA on ADT a harbinger of biochemical recurrence? Is there a threshold value above which you are concerned (ie. 1.0 vs  0.5 Ng/mL...

When treating a NSCLC with extensive bilateral mediastinal disease +/- supraclavicular nodes, would you recommend exceeding certain tissue constrains ...

For example, would you consider high tangents in a patient who did not undergo SNB due to age and comorbidities, but has high risk features such as gr...

 If so, do you have a threshold for number of involved sites i.e. X lesions in Y organs, etc.

Are there any anatomical changes that would make the placement impractical or hurtful for the patient?

ACOSOG Z11102 mandated radiation with a boost. Hypofractionation was prohibited. This isn't how we practice nowadays and some women might otherwise me...

This assumes no current local pain symptoms or spinal cord compression. Does this recommendation change based on histology? Any other factors to consi...

Would you consider it for a patient with good PS but with limited metastatic disease? What dose fractionation would you prefer?

Patient with stage IIB cervical cancer treated 8 years ago, now with large (>10cm), isolated, symptomatic recurrence involving the left SCL and med...

If so, would you recommend adjuvant chemotherapy and PCI after?

RTOG 0815 protocol says 1 cm from base of SV in any direction. Some contour the SV visible in the slices within 1 cm sup/inf from base of SV.  P...

Recent results from the STRASS trial suggest limited benefit from preoperative radiation therapy for retroperitoneal sarcomas.  https://pubmed.n...

Is it possible or common for patients to have mucosal telangiectasias along the portions of the GI tract in the radiation fields? If present, would yo...

Would preop RT still be the treatment option for these kind of patients? Assuming that the rectovaginal fistula was from tumor progression.

Would you go to a higher dose for the primary and/or nodal volumes? If the medical oncologist does not feel comfortable giving cisplatin or mitomycin...

Do your constraints change when treating standard fields for T3 disease versus including external iliac lymph nodes for T4 disease when treating with ...

What dose/fractionation do you prefer? What is the maximum dose that you will allow to the optic nerve and chiasm?

There does not appear to be any guidance from the most recent published protocols on this topic. For individuals with dementia, recommendations call f...

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

What dose/fractionation would you use for treatment of a tumor without a biopsy?

 Does your dose recommendation change if a patient has cord compression or has undergone surgery? There is a range of doses in the ILROG guidelin...

The patient went straight to gastrectomy for clinical T1 gastric adenocarcinoma, but post-op was up-graded to T4 disease.   Both ARTIST and Inte...

If the oligometastatic lesions are not longer PET avid after neoadjuvant chemotherapy, would you consider further treatment with local therapy or obse...

Would you offer SBRT to both sites, SBRT to the primary and standard fractionation to the node due to proximity to the main bronchus/proximal lobar br...

Do you contour cardiac vessels and/or heart substructures? If so, which one(s) and what dose tolerances do you assign them? 

This particular case involves a patient with a frontal scalp low grade eccrine carcinoma status-post excision with positive margin complicated by...

If proton therapy is not available would you consider radiosurgery? How would your management differ if residual disease is present?

 If a SLN biopsy could not be performed and only a few lymph nodes were removed by ALND that were negative, would you treat the nodes? What facto...

Would there be concern that the false negative rate be too high with a SLNB alone?  Is this mitigated by having the clinically involved node clip...

In a patient who has undergone prior cryoablation for prostate cancer and develops a biopsy proven local recurrence, what dose and fractionation would...

What-dose fractionation would you utilize? What small bowel constraints would you optimally set to achieve? How would your approach differ in a surgic...

Do you consider Macdonald type sandwich treatment 45Gy with xeloda? Would you dose escalate gross node? Would you treat stomach remnant and regional...

After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...

Given CHAARTED and STAMPEDE, what would you recommend? Would lymph node vs osseous mets change your recommendation given the trial did allow patients ...

Mini-tangents only? 3-4 fields including lightly weighed perpendicular to chest with some exit dose to lung?

This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...

Since only part of the breast was treated before, would you include treatment of the whole breast now, despite no detectable disease?

The treatment of ITC and micrometastases in lymph nodes in women with breast cancer is controversial. Given the rarity of male breast cancer, complex ...

When, if ever, would you consider up-front SRS for first line therapy?

Under what circumstances would you treat elective nodal regions? Would you consider treating the ipsilateral hilum if it was not PET avid?

How reliable is MRI only diagnosis of prostatitis? Assume no prior PSA and Group grade 2 or 3. Would you treat prostatitis? How do you deal with ADT e...

Definitive RT only?  Concurrent chemo-RT? Technique, dose (for radiation and chemo, if any), fractionation?

Would you offer EBRT alone or EBRT with vaginal cuff brachytherapy after surgery and chemotherapy for stage III (T3N0) carcinosarcoma of the uterus? ...

Would you observe or radiate?What volume, dose, fractionation would you use? Systemic therapy?

A HA-WBRT patient developed brisk mucositis on the soft palate at fraction 8/10

While protocols describe using a D2% constraint, there is little description of what should happen to the DVH between 30-37.5 Gy.  It would ...

How do you decide on other chemo regimen? (Dosing, frequency, carboplatin based, non-platinum based etc.) Would you use Cetuximab? Altered fractiona...

If biopsies consistently show high grade adenoma and there is a locally advanced rectal tumor with MRF involvement on imaging, what is the next step i...

How would your recommendation change for a lesion within a non-radiated field versus a previously radiated field? What about an oligoprogressive lesio...

Given the length of the scan and higher likelihood of patients being unable to hold their bladder, do you deviate from CT simulation and treatment ins...

Given the proximity of the optic chasm and risk of compromised hemianopsia, the lack of adequate central vision adds another layer of risk.

What do you do/say when a discussion of evidence-based information doesn't convince a patient that this is her best chance of cure? Some patients even...

Would you consider it for a patient who had bulky thoracic disease, only a single extrathoracic site of involvement and achieved a CR after induction ...

Would you recommend locoregional radiation therapy or systemic or immunotherapy alone? If you would consider radiation therapy, what would be your rec...

What dose would you consider for patients with bulkly pelvic disease and in what situations would you, if ever, dose escalate for local disease with b...

Small bowel is usually the dose limiting OAR while planning cervical HDR brachytherapy. Having the bladder empty during treatment planning and deliver...

If there is hilar LN involvement only, could you consider hypofractionated RT? 

Would you treat the primary site alone, include the hand and arm lymphatics to the epitrochlear nodes (one continious treatment volume from hand to el...

At what point would you recommend transfusion? At what point would you stop radiation?

I’ve noticed some patients develop worsening SOB and DOE months after RT and rather than interstitial diffuse pattern you would see with pneumon...

Do you ever allow patients to receive a couple of cycles of systemic therapy first if there is high burden of disease? What is the maximum time after ...

In the case of a nodal mass of several nodes matted together due to ENE but without apparent ENE at the surface, does your management change? Is ENE ...

What factors do you consider when offering retreatment? If you use repeat-SRS, what dose and fractionation?

Has anyone omitted post path fracture radiation of pelvis/long bone in favor of starting endocrine treatment first? Or would one omit RT and start a C...

I can't convince the surgeons to refer their patients for adjuvant RT because the prospective data is messy and doesn’t seem to indicate a benef...

For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?

In which situations would you consider 37.5 Gy / 15 fx or 20 Gy / 5 fx over 30 Gy / 10 fx?

In a case with negative margins, T1-2 primary, no ECE, no perineural invasion, etc, is adjuvant radiotherapy indicated based on N2a stage?

Do you include external iliac nodes as for T4b (adjacent [anterior] organ invasion) or do you maintain the same coverage you use for T3 disease with a...

Should the VP shunt be moved prior to RT?  Are there any complications of radiating a VP shunt?

More specifically there is no testicular invasion - would you cover the entire scrotal sac? What lymph node stations if any would you cover?

Are there general ages that you refer to in terms of risk of secondary malignancy or points dropped for IQ over time after treatment, or particular he...

Should they be context/disease specific?  Should use of chemotherapy before/after, or during radiotherapy modify these tolerances? Contexts: ex...

Stage 4/group 4 due to dissemination in peritoneal fluid. Translocation negative; treated per intermediate risk protocol on study arm ARST1431 VAC/VI ...

I have seen cited bronchus - smaller airways V32Gy<0.5cc and max point dose 40Gy for stenosis with atelectasis, but unsure sure if this is used in ...

Do you hold Avastin before and after radiation therapy? Do you avoid radiation in these patients? 

Does margin width play a role in your decision making? Would no tumor on ink be acceptable?  What if there was LCIS in the specimen as well with ...

Would your answer change in the postop setting for a tumor right above peritoneal reflection with positive pelvic nodes?

Would implant reconstruction prior to radiation therapy change your recommendations? Would you ever treat just the nodes and omit the chest wall/recon...

If so, what dose would you consider in the setting of complete and incomplete repeat surgical resection? How would you sequence this with salvage sys...

How can this be done logistically to coordinate the proton boost off site? Should everything be done up front? How are the logistics regarding plannin...

The patient received R-EPOCH followed by consolidative RT (36 Gy in 18 fractions) approximately one year ago and was subsequently salvaged with RICE.

For a patient with good response to immunotherapy (unable to receive chemotherapy due to kidney function, comorbidities) where previously avid LN have...

If a patient meets all omission criteria per CALGB and PRIME except age would you consider omitting RT? Is there any evidence for such an approach?

The interval since prior resection is between 3-5 years. Additionally, there is some evidence of nodal involvement but no evidence of metastatic disea...

With the recently reported START (A and B) trial data from the UK, in which patients were allowed to receive hypfractionated doses to nodal regions, i...

How long is too long to resume SBRT, and would you increase doses? Is there a number of elapsed days that would cause you to abort completion of SBRT?

Would you consider additional EBRT or vaginal cuff HDR in a patient with previous tx with EBRT (45Gy) + HDR (30Gy) for a R1 resection with a radial ma...

Would your recommendation change if the patient had prior radiation proctitis and cystitis (now resolved)? Previous treatment records limited, but pre...

When do you decrease your SRS dose or consider fractionated SRS regimens?

Would you recommend adjuvant radiotherapy for a patient with positive margins for in situ disease with negative margins for invasive disease? If so, w...

Re-excision would result in amputation. And the patient had attempted pre-operative RT but quit at 16Gy due to toxicity/social reasons. Would you trea...

Does time since adjuvant cuff brachytherapy influence your radiotherapy approach, (for example 18 months vs 5 years)? Do you adjust your bladder/bowel...

The upfront plan is to use a definitive radiation dose of 66 Gy. My reading supports the use of 5FU + cisplatin but another doctor is recommending FOL...

Is diverticulosis in large bowel adjacent to a target a contraindication for SBRT? How would you manage?

The recent NELSON trial evaluates screening in a slightly different population than the USPSTF/NLST criteria. Which will you follow?

Would you boost the area of positive margin? Would you include the expander?

Assuming the patient is otherwise a candidate for APBI.

Do you use a standard margin around the mastectomy scar (ie 2cm sup/inf), or do you extend the field to include the entire chest wall?

Would you omit radiation therapy for some patients with Li-Fraumeni syndrome who would normally receive it?

Would you consider hypofractionation? If so,what dose? Would you consider a boost if there were close margins?

Would there be any indication for postoperative RT if cervical lymph nodes are negative?

Should this be based off of the response? or the site of disease such as bone vs soft tissue?What data are there to dictate that the prior (response, ...

The margins vary widely in the literature (Roa et al utilized edema +2cm while Perry et al utilized T1+C +1.5cm for CTV). 

Assuming no other sites of disease on staging scans, surgery is not an option, and the patient is otherwise healthy with reasonable life expectancy. W...

I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context ...

Would you use general sarcoma expansions or would smaller expansions like the ones in head and neck would be reasonable?

How do the recent results from E2108 impact your practice? Would you consider locoregional therapy in patients who are good responders, have oligets, ...

How about in the setting of treatment after recurrent resected disease if it didn’t involve the skin: would you push for coverage even though pl...

Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT?  What if the size is >5 cm?

Should these patients be managed with high dose chemoradiation similar to the Danish study (Lancet in July 2015)? To what dose would you take the prim...

How does the presence of prior WBRT alter your treatment plan?

Would you have reservations in treating patients with breast, GI, or pelvic malignancies with radiation alone or concurrent chemoradiation?

Do you cover the entire involved vertebral body with an elective dose volume (similar to spine mets)? How do you balance cord tolerances with coverage...

Assume this is a PET Axumin avid node and is only site of disease. Previously this high risk prostate cancer patient had 45 Gy to the whole pelvis and...

Is surgery still indicated? If no surgery is pursued, (how) would you deliver consolidative radiation therapy?

The CRITICS trial showed there was no OS or PFS benefit with adj chemo vs CRT. Is there potentially still a role for CRT to reduce heme toxicity and p...

What do you utilize for patient immobilization and what are your PTV margins? What MRI sequences do you favor for target delineation?

Specifically, when treating a tumor located in the head and neck region, would you consider treating closer to 64-66 Gy? Or would you be consistent wi...

Is there data to show efficacy of radiation in this situation? What dose/fractionation/volume?

http://abstracts.asco.org/199/AbstView_199_180760.html http://abstracts.asco.org/199/AbstView_199_187537.html  

Given the poor prognosis of molecular subtype, do you offer a more aggressive treatment regimen than for other molecular subtypes of low-grade glioma?...

Any dental extraction of the mandible could lead to healing problems and thus delaying reirradiation. 

How high would you try to boost those involved nodes if they are in a favorable location with respect to his rectum and small bowel? 

In this example, the patient had a resected melanoma with negative margins and the specimen was noted to have two nests of tumor cells in the deep der...

Would you offer definitive or neo-adjuvant chemo-RT in the setting of a single lung or bone metastasis?

When is SBRT appropriate? Do you approach dose and fractionation differently in this setting?ƒ

Based on recent data published suggesting an OS advantage to the addition of ADT vs. brachytherapy boost to EBRT (Jackson et al, 2020), it is unclear ...

In the HERO trial, relugolix, a highly selective oral GnRH antagonist, demonstrated faster and sustained castration, faster testosterone recovery, and...

Would you consider it off-trial during the pandemic? There is some older data for treatment of pneumonia with single-fraction low-dose radiotherapy, w...

If the patient had high risk features (for example age 60+ and LVI) do you treat with vaginal brachytherapy or WPRT? If you treat with whole pelvis ra...

Any differences in the risks between SBRT vs. conventionally fractionation? Concurrent immunotherapy? 

Do you treat the whole bladder in the intial whole pelvic field to 45-50 Gy?

Are there certain situations where a hydrogel spacer is most useful based on treatment modality (SBRT, protons, brachy, etc) or other factors?

I care deeply about clinical trials but have always struggled on how to approach this topic. I would really appreciate tips from those of you who have...

Do you ever recommend TURP, short course of ADT or other treatments prior to RT to downsize?

Do you worry about chest wall necrosis? Is surgery preferable? Does the previous RT affect your dose and fractionation? I am seeing more patients with...

i.e. Should concurrent therapy be given?, Does MGMT matter? What are the current most promising therapeutic approaches? Should we always treat based o...

There seems to be a wide variety of palliative doses used in clinical practice (8 Gy x 1, 2 Gy x2, and 20 Gy in 10 fx).  Do you have a preferred ...

What fractionation scheme would you use?  Would you give SBRT to a hilar tumor that has N1 nodal involvement adjacent to the tumor but can be enc...

Given the location but no other high risk features would you offer RT?  If so, what dose and fields? 

If an external boost of a gyn primary is necessitated because of the target size or extensive involvement of a critical structure how would ...

What dose constraint would you use for the neobladder? Small bowel constraint of 54Gy? Or would you recommend observation or ADT alone or low dose RT ...

How do you choose between Avastin, hyperbaric O2 and other therapies?

In patients with cancers involving the lid requiring superficial x-ray treatment, I use an internal eye shield placed under the lid to protect the cor...

How would tumor grade, presence of LVSI, and receipt of chemotherapy factor into your decision?

Higher radiation dose was shown to be associated with longer survival in Tao et al., JCO 2016. What dose constraints do you use when using these ...

What would be your radiation dose and target volumes? Concurrent chemo? Would you offer neck node radiation if no neck dissection was done?

In a patient who received full dose to the spinal cord 10+ years prior, would SBRT be appropriate salvage therapy or is hyperfractionation prefer...

What advantages/disadvantages are there over OncotypeDx DCIS assay or traditional clinical pathologic factors? What other concerns do you have?

Specifically, for a melanoma of the axilla with proximity to the brachial plexus, how would you approach such a case to minimize chance of radiation-i...

Would you consider this if the patient does not appear to have hippocampal involvement? Or is the risk of subsequently developing hippocampal metastas...

When deciding to treat what would be your dose/volumes? And would a re-staging scan play a role in your treatment planning?

Does the elapsed time from prior chemoradiotherapy impact your selection of dose/target volumes?

If a patient with a high grade sarcoma has gross residual/recurrent disease after resection and cannot undergo further surgery - would you boost this ...

The protocol for the James trial (NEJM 2012) states: "non-target tissue may be excluded at the discretion of treating physician." For gyn applications...

Do you encourage patients to take a break from/stop taking Fosamax or similar medications for their osteopenia or osteoporosis in order to prevent dev...

What dose/volumes would you recommend for a previously radiated tumor not amenable to surgical resection?

This has been a common practice in the community. Is there a benefit for certain patients?

In a patient with early stage breast cancer that would otherwise require radiation, would you recommend treatment if the patient has active skin lupus...

Would you manage this histology any differently relative to other low grade gliomas? Is a STR a definite indication for postoperative XRT?

Are you doing more TNT to prolong time to surgery? If so, do are you starting with CRT or chemotherapy?

If yes, do you recommend it be given concurrently with chemotherapy or sequentially? What is your target volume and dose?

When would you offer re-irradiation in the setting of prior RT and tumors not amenable to gross total resection? 

Consider 6 fractions weekly chemoRT? Add cetuximab to chemoRT? Proton boost? Induction chemo prior to chemoRT? Interstitial H&N brachytherapy boos...

Would you be concerned with more and higher grade hepatobiliary toxicity with concurrent use of checkpoint inhibitors (i.e. Keytruda)?

What if it was status post partial resection? And had bilateral level 2 lymph nodes?

Any comments/recommendations regarding the UK approach using 52.5Gy in 20 fractions (Chin et al., IJROBP, 2020)?

Is there a contraindication to radiation therapy for prostate cancer in patients who are carriers of ATM mutation? Would you offer surgery upfront? Hy...

Would you consider reirradiating the breast and regional nodes? Further axillary surgery? Partial breast radiation? Or other?

Assume PSA less than 0.5. Would axumin positive nodes change your mind? What dose do you use? Do you require biopsy first to prove pathologic nod...

Would you recommend conventional fractionation or moderate hypofractionation over SBRT or brachytherapy?

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

Would the degree of response (pCR vs no pCR) influence your decision making?

Is there a certain age beyond which it is not safe to do SBRT?

When using short course RT, the NCCN guidelines currently recommend short course RT followed by chemotherapy, followed by surgery. Many surgeons are h...

We sometimes find highly suspicious LNs by CT, PET or MRI in the undissected regional lymphatics, and surgeons may not be willing to perform another o...

What is your preferred combination and order of therapy for a T4 rectal tumor invading the uterus leading to both rectal and vaginal bleeding?  ...

Guidelines do not provide strong guidance on who will benefit from temozolomide vs PCV or when to consider re-challenging with temozolomide.

Are pre-treatment PFTs actually correlated with treatment-related toxicity? If no absolute cutoff, do you have an ideal lower limit for PFTs...

Dose is change based off of the radiation toxicity, such as poor wound healing vs radiation proctitis? What is the minimum amount of time that you wou...

The patient in question developed this new primary 3 years after prior chemoradiation. What dose constraints would you apply if treating with reirradi...

Do different modalities of imaging (PET vs MRI vs CT) help you to distinguish one etiology versus the others? What about other clinical characteristic...

The traditional 2-field parallel opposed field technique irradiates the whole larynx to the same dose and includes unaffected structures.  This ...

Our hospital is currently testing (PCR) for COVID-19 in all inpatients and outpatients undergoing surgical/"aerosolizing" procedures. Since radiation ...

i.e. T4 sinus tumor with advanced orbital invasion? Would your opinion and approach change in the event the patient responds favorably to neoadjuvant ...

Would you consider this even though this falls out of scope of STAMPEDE trial? Under what circumstances would you consider such an approach versus not...

For those of us just transitioning over to hypofractionation, what are reasonable, but conservative, constraints that you use?

For example, a heavy burden of nodal disease with diffuse ECE?  Would you treat the axilla higher than 45-50 Gy?  What would you use for a b...

What is your recommended dose/volume for large tumors s/p limited resection? What dose constraints do you use for the visual pathways?

Do you treat on consecutive days or more protracted interfraction intervals? Does tumor type (benign vs malignant) or size influence your choice? &nb...

My understanding is that this risk is exceedingly rare even with treatment in and around the stalk and hypothalamus. 

Are you employing more or less primary chemoRT v. surgery for some cancers? Are you dose de-escalating? What are issues radiation oncologists should b...

How do you counsel a pre-menopausal female with endometrioid cancer desiring definitive RT with egg harvesting and IVF for fertility preservation inst...

Would you treat the nodes with margin, the nodal group, or the whole untreated mediastinum?

From my review of literature, the rate of contralateral neck failures with ipsilateral radiotherapy for lateralized tonsil T1-2 N2a disease is very lo...

If so, do you give RT before or after adjuvant chemotherapy?

Is this different for de novo or reirradiation cases? Would you recommend avoidance of the nerve roots if there is gross disease present in these area...

Is there data that hilar location is a contraindication? Any increased risk of ureteral stricture or other unforeseen issues? What dose/fractionation ...

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

I know many centers are exercising extra precautions in light of the new concerns with coronavirus. How are people explaining things to their patients...

If normal tissue constraints can be met, should most patients (including ones with secretory tumors) be treated with radiosurgery and/or hypofractiona...

Is this one of the factors you use when deciding between repeat SRS vs. whole brain radiation therapy for distant brain relapses?

Please see this article for referrence https://www.sciencedirect.com/science/article/pii/S0167814020301638

The unfavorable risk factors for stage I-II Classic Hodgkin's Lymphoma differ depending on the cooperative group (GHSG, EORTC, NCCN), which criteria d...

How do you prescribe a steroid taper? If it is grade 2, would you keep them on low dose prednisone while continuing? When do you feel comfortable re-c...

For those that tend to contour rather than set fields based on bony anatomy, how do you draw your CTVs? 

Aside from smoking cessation, what interventions have you found useful to manage patients with chronic symptomatic laryngeal edema? Steroids seem to b...

Is there such thing a definitive radiotherapy in this setting, or would this be a purely palliative approach? If you would treat, what would your targ...

Didn’t 0129 establish no difference between conventional vs Accelerated RT with the same Cisplatin regimen? Are there still thoughts of benefit ...

For example, would you consider switching to an outpatient regimen in lieu of AIM for metastatic soft tissue sarcoma?

If so, what dose-fractionation regimen do you utilize? What are your target volumes?

What pathologic features are most important when evaluating the possible need for adjuvant therapy?

Is there data to guide treatment re: SBRT vs. concurrent chemoradiation vs. sequential therapy vs. systemic therapy alone? Does the nodal location imp...

Many hormone positive patients are beginning hormone therapy until they can go to surgery. With a prolonged pause in routine procedures seeming very l...

What dose fractionation and volume do you use? What factors influence your decision?

Should staging and treatment decisions be made based on imaging alone?

Does your recommendation change depending on the disease-free interval?

In the case of multiple skip lesions in the thoracic esophagus and GE junction, the PTV may encompass nearly the entire esophagus, including the supra...

How does recommendation change if this a favorable intermediate, unfavorable intermediate or high risk patient? Is additional imaging or biopsy recomm...

Would your recommendations change if you were treating a GI primary (e.g. rectal or anal cancer) vs non-GI primary? 

Do you consider this regimen based on the 10 year results of the UK FAST trial?

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

Scanning beam only machines are being increasingly marketed, it could be problematic if you can't use them to treat the one site which is most appropr...

Is it possible to get a good measurement with TLDs? TLDs can overestimate the surface dose by 10 - 40%. Do you use a skin diode measurement on the fir...

I've been prescribing sucralfate as first line symptom management but I sometimes see zero benefit. The randomized data doesn't support it's use eithe...

If so, for how long would you expect this increased susceptibility to last? Our medical oncologists often tell patients that their lymphocyte counts m...

Are your practices adjusting priorities at this time? If so, what adjustments are you making? If not, do you have metrics in place that will tell you ...

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

For example, a patient with SCC of the H&N and has a lung mass that is SCC, would these be two separate primaries or metastasis? What is the best ...

The more recent NWTS trials do not include these tumors, since rhabdoid are recognized to not be similar to Wilms, and the AREN0321 does not provide s...

Should the patient be admitted for observation which will risk exposing other immunocompromised patients to COVID-19, or should the patient be quarant...

When a physical exam is important and telehealth is not a good option, should we be proactive and reschedule or should we continue to see them as sche...

Mitigating the spread of COVID-19 is of utmost priority now that containment measures have failed. Social distancing will help "flatten the curve" of ...

We have been receiving referrals for oligoprogressive SBRT for multiple primary tumors (NSCLC, Colorectal, Renal Cell, etc.) in the setting of diffuse...

Also, how would you handle immune modulators for rheumatoid arthritis during their treatment?

For those of us who are just starting out in practice, do the seasoned pros have any advice?

If a skin flap was required due to necrosis after the mastectomy, would you still provide PMRT assuming the patient is high risk?

How do you prevent early menopause in women? Please comment on freezing of eggs, oophopexy, supine vs prone position, vaginal dialator. 

Would you consider using radiotherapy for persistent malignant pericardial effusion?  What dose-fractionation would you use, and what would your ...

Is there specific workup you perform? Are there preventive measures? Once established, are there non-pharmacological and pharmacological treatments yo...

What dose schedule would you use to treat plantar fibromatosis? How soon after resection would you begin treatment? And how happy were you with the re...

When indicated as in the setting of positive margins and/or positive lymph nodes, do you use V45 <195cc (QUANTEC), or V45 <15% (RTOG 0848), and ...

Do you extrapolate from the pediatric protocols (smaller margins) or use larger margins similar to treatment of adult high grade gliomas?

If the patient has an asymptomatic local recurrence of a CNS ependymoma previously treated with a full course of radiation, would you re-treat with ra...

As we see more TORS being done, we sometimes run into the above scenario which could have been cured with RT alone. Do you add concurrent chemotherap...

Given the recent results of the NRG/RTOG 1014 trial, would you consider it reasonable to offer breast conservation for women who meet the trial entry ...

If a non-contrast CT is not performed at CT simulation or otherwise not useable, can you plan on the contrast CT or must you re-simulate for cancers n...

Guidelines indicate RCHOPx3 +RT as category I and RCHOP x 6 below that; long term f/u for SWOG 8736 showed similar PFS and OS. Do you have and approac...

When do you offer preop RT (50Gy) before the re-excision? When do you offer post-op RT after the re-excision?

U of Alabama paper states no max dose constraints used but they try to keep V60 < 10% or 10 cc (these constraints appear to be difficult to achieve...

Would you consider SBRT and if so what dose/fractionation would you use if the lesion was in the head of the mandibula? If not would you give a fract...

NCCN recommends achieving margins of 2.0cm or at least the size of the lesion, but assuming the patient did not have adequate lung function for lobect...

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 ...

In a patient with a positive SLNBx, would triple negative or Her2+ status affect your decision on whether or not to proceed with a full ALNDx?

Would it be acceptable to treat a patient with locally advanced breast cancer (ex pT2N2a) s/p lumpectomy with a short course 4 week treatment ins...

*What dose and fractionation do you recommend for metastases >4cm in favorable positions (ie. not abutting mucosal tissue)? 

Would you consider this standard in asymptomatic patients for workup and treatment planning? Or do you reserve MRI for symptomatic patients only?

For that occasional "single lymph node metastasis" referral in patients with no other sites of disease, is there a therapeutic dose below which you're...

Generally, the margins are uncertain in this scenario and re-excision is usually not possible.

Insurance authorization for protons is pending, but if the patient cannot have protons would you treat with standard fractionation to ~70Gy or conside...

I always wished that I received more guidance as a resident. As a result of not having been mentored myself, I feel like I don't know how to be a good...

Total neoadjuvant therapy consisted of with FOLFOX and chemoradiation therapy with Xeloda and 50.4 Gy. Would you deliver a boost to the area and if s...

The case in question is a radiation-induced spindle cell sarcoma at the thoracic spine previously treated for a plasmacytoma to a dose of 60 Gy in 30 ...

Most trials establishing CRT as standard of care for IIIB NSCLC excluded patients with separate ipsilateral lung nodules given that they were categori...

Do the potential late effects offset any benefit of mediastinal XRT in a young patient with bulky disease?

I have always used the RTOG standard 2cm margins off the T2 Flair to 46Gy and 2cm off the T1post for the 14Gy boost. However recently I have heard of ...

Is a positive imaging enough to confirm the diagnosis? If not, what situations are appropriate for a biopsy?

NCCN recommends brachytherapy plus or minus pelvic RT for surgically staged Grade 1, Stage II patients, but these originally staged IIB patients were ...

Would a combination of other adverse features such as PNI, GIII, close margin, multiple positive nodes, T4 disease and others make you recommend chemo...

How would a much higher risk cancer affect decision making? How would you treat him? 

For standard tangential radiation would you pull the field edge forward to avoid radiation dose to the entire implant?  

For both the primary and re-resection surgeries, resection was achieved via both scrotal and inguinal incisions. And margins were reported as negative...

For a patient with an access to proton beam therapy, what dose regimen would you use in the context of a locally recurrent esophageal cancer, previous...

Sometimes wound healing can delay adjuvant radiotherapy by several months. For aggressive histology, such as high grade sarcoma or skin cancers, is th...

Is your approach to simply calculate the EQD2 for specific lung constraints from the prior SBRT and add to the current plan to use cumulative standard...

Is your size limit a function of OAR dose? If yes, is there a volume of bone that you will not exceed regardless of no dose-limiting OARs?

If a patient has had a diagnostic MRI, can you obtain another planning MRI after fiducial marker and SpaceOAR placement? 

Z11 and AMAROS tell us that in cN0 patients, an adequate ALND is considered definitive treatment, but what about patients who have low volume biopsy p...

Concurrent? Neoadjuvant and concurrent? If neoadjuvant, how long before? 

If a patient was administered GM-CSF during concurrent chemoRT, would this be an indication to hold RT, regardless of cell counts (e.g. based on Bunn ...

*Negative margins, <1cm in size, no LVI, negative SLNB, not immunocompromised, no prior surgery (as well as a negative PET/CT scan).

What dose/fractionation do you use and what elective nodal areas do you cover? What studies do you order to aide in treatment planning (PET/CT? MRI?) ...

Would you be more mindful of bladder dose or hotspots? Are urinary outcomes different if the surgical procedures are done before or after radiation?&n...

Specifically with reference to rural settings where the logistics of early in the week delivery may be more challenging.

Patient had superficial parotidectomy, with negative margins. No nodes on imaging. Specifically, treat parotid bed alone? Add nodes if N0 on scanning?...

What size cut off or other factors (i.e. LVI) do you consider? Do you only treat IMN and medial SCV vs include entire axilla if only SLN? 

Assuming there is no other locoregional or distant disease.  Would you treat the entire contralateral chest wall? Nodes?

Temodar can sometimes take 2-3 weeks to arrive after prior approval. Would you start radiotherapy without Temodar or wait for it to arrive and begin c...

How long do you allow for response before deeming it suspicious for residual disease? What work up (imaging, biopsy) do you recommend? How do you sa...

Patient had multiple positive margins and is on ADT.  What would your treatment volumes be and to what dose?

What dose constraints would you prioritize for the esophagus, given that a long segment of esophagus will be in PTV?

Do the results of the unplanned subset analysis of the PACIFIC trial showing no OS benefit in this population lean you away from consolidation?

What is your preferred dose/fractionation? What constraints do you utilize for the brainstem and cord?

Do you recommend before and/or after procedures? Do you have the same recommendations for any or all the below: hydrogel space, fiducial placement, LD...

How (if at all) would you modify your target volume if the hemorrhage was present on immediate post-biopsy CT, but resorbed by time of CT sim? What ab...

Our medical oncology team wants to give a patient Vitamin B12 and Folate 1 week before chemo- do we need to push back the RT start date to start both ...

This question has come up most frequently with respect to the flu vaccine recently. Also, frequently this has been asked about the shingles vaccine an...

Given the publication by Malone, et al (JCO, 2019), how do you sequence ADT relative to the start of RT? https://ascopubs.org/doi/full/10.1200/JCO.19....

Adverse features include increased nuclear size, nuclear atypia, and mitotic activity up to 10/50 HPF.

Do you routinely include pelvic lymph nodes, prostatic urethra, and prostate?

Do age or margins factor into your decision making?  What dose and fractionation would you use? 

Would you recommend it for a mammographically occult primary or if the patient had dense breasts?  What if a high risk patient decides not to hav...

To minimize the likelihood of asymmetrical growth, when is it of sufficient concern to necessitate altering planning objects? When planning paediatri...

If so, how do you address the Joint Commission's cleaning requirements? The Joint Commission recently inspected our hospital including the radiation o...

Benzodiazepines are not ideal in this population. Are there superior alternatives, perhaps antipsychotics, that are effective and superior?

Does tumor location play a role (central vs peripheral) in making the decision?  The question stems from an oral presentation at ASTRO 2014 inves...

Since there is no overall survival benefit, does the local control benefit outweigh the increased risk for distant metastasis? How do you select patie...

If re-resection would yield negative margins, is observation appropriate? Does the presence of focal PNI push you toward adjuvant RT (without re-resec...

Are there exercises, massage techniques, or support garments that are effective at preventing or reversing lymphedema of the breast?

Patient had neoadjuvant ADT. Are there any preferred isotopes, seed activities, etc for small prostate brachytherapy?

Do you routinely employ dental wax? Does it depend on the material (titanum vs. other)? Do you take the extra time to replace metal with porcelain whe...

For a stage IAE DLBCL (in this case, of the oral cavity) that was completely excised, s/p R-CHOP, is the ISRT target volume just the preop volume plus...

I have a patient with metastatic NSCLC and a concurrent head and neck primary.

In patients who have a mixed response or progression and are poor candidates for other systemic agents, would you consider consolidating the chest? Wo...

Any difference if patient is undergoing HDR vs LDR? For example, prescription doses are 45Gy for EBRT and 10.5Gy x 2 for HDR boost. 

How do you account for the change in tumor volume? Do you use pre or post-chemo volume? Do you alter dose based on response?

i.e. doxorubicin, ifosfamide + RT. Do you worry about decreased locoregional control or increased toxicities with the use of G-CSF in combination with...

Is there evidence that supports/refutes the safety of concurrent use?

If there were negative margins, what other factors would you consider to add adjuvant RT? Size of the tumor or depth of invasion?  

What are the indications for local control of the breast in patients with metastatic breast cancer?

A recent study http://www.ncbi.nlm.nih.gov/pubmed/27480153 showed an improvement in bichemical failure with higher doses. How much impact do...

The German trial included patients with tumors up to 16cm from the anal verge, while the Swedish trial update found no local control benefit for tumor...

NCCN allows a range from 5.4-9 Gy for adjuvant boost and German trial used 55.8 Gy. What factors might sway you to give a higher / lower dose? Is mor...

Do you still follow the atlas guidelines and contour the breast to the latissimus muscle laterally the the pectoralis muscle posteriorly or since the ...

-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX. -Given that this is standa...

Would you give a more definitive dose (e.g. 60 Gy/30 fractions) or follow the CREST trial (30 Gy/10 fractions)?

For the management of stage II endometrial cancer, NCCN says pelvic RT and/or vaginal brachytherapy.   Do you ever add vaginal cuff boost to pelv...

Do you treat in this scenario if mild/moderate infiltration? What are your thoughts on the article Fischer-Valuck, et al, PRO, 2017 (PMID: 280895...

Would you recommend radiation to the prostatic fossa and/or the oligometastatic site? How would you dose these areas? Would you recommend ADT?

Do you routinely recommend TTF in the adjuvant setting for patients with glioblastoma?

For instance, if the fluclicovine scan shows a few small avid nodes not only in the pelvis but extending to the paraaortic region, would you treat the...

Alliance Z-1071 cohort had 5% with cN2 and <1% fixed or matted and the current Alliance trial 011202 only allows cN1. ALND has never been shown to ...

If there is a pCR in the breast and nodes do you treat the breast/chest wall SCV and full axilla?  IMNs?  Would the type of surgery (lumpect...

Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...

Recurrence is in the radiation field right at the border of graft and scalp, and started to surface at about 20-24 Gy. It is visibly enlarging over se...

Would your recommendation change with the following aggressive features: 8 cm, pericolic extension, positive radial margin, perineural invasion presen...

How does grade affect your decision-making? If adjuvant radiation is indicated, should the initial extent of disease be included or only the post-oper...

For what is clearly a oropharyngeal primary, with clear extension up the soft palate and into the nasopharyngeal lateral wall, should the intermediate...

Would you suspect progressive disease v. radiation necrosis vs optic neuritis due to immunotherapy. Eyes were within radiation field 8 months ago.&nbs...

The patient's urologist will not offer testosterone supplementation unless he undergoes definitive therapy of his early stage prostate cancer. Are the...

Does your surveillance schedule change dependent upon delivery of SRS vs conventional-fractionated RT?

NCCN recommends annual CT surveillance indefinitely after year 5, but I’m curious how many physicians continue and for how long?

The patient had an initial partial vulvectomy and nodal dissection 6 years prior to recurrence, with no adjuvant RT offered initially due to lack of c...

Would you alter your SBRT dose? How long would you hold the VEGF inhibitor before and after? Does the primary matter (e.g. NSCLC vs. colorectal)?

When covering with radiation what dose and technique do you favor, electrons, IMRT, brachytherapy, protons?

The NCCN seems to make its recommendation based on extrapolation from colon cancer, but those patients are not treated with pre-op chemoRT.

If so, what dose-fractionation regimen do you utilize? What are your target volumes? Would you first recommend induction chemotherapy followed by rest...

Do you think about it in the same way as DCIS in terms of radiation decision making (i.e. grade, margins, age of patient)?  Is Paget's disease le...

Specifically, how do you explain potential cognitive decline in a way that explains what changes they can expect in their daily lives?

The patient is not a transplant candidate due to multiple co-morbidities. Some of the sites in question have had a complete response and other have ha...

For instance, would you be more inclined to treat a patient with T3N0 disease and no other risk factors?  What if there were a small neighboring ...

Based on the RADICALS-RT trial presented at ESMO, can RT be omitted in post op prostate patients in favor of salvage RT? If not which group of patient...

Do you recommend for EUA/biopsies/tonsillectomies to look for primary as well as neck dissection (at the same time to save a trip to the OR), or attem...

Do you prescribe to 5mm/apex or use a margin? Do you add time for tumor growth or allow less than the prescription dose to the apex?

Patient being treated for cervical cancer noted to have a < 1 cm posterior vaginal fornix defect with a small focus epiploclia herniating into the ...

If there was still was PSMA PET/CT activity in the prostate after a year of ADT would you offer RT to the prostate +/-nodes? 

Does time interval from initial radiation therapy matter. Assume this is in the case of castrate resistant prostate cancer in which all other avenues ...

 Assuming the answer is quite low, the next question is why?

Will your recommendation change if there is suspicious/confirmed locally recurrent nodule in the prostate bed?

For instance, in a woman with small volume disease in the breast, is your posterior border still the lung interface?  Do you cover all drain site...

Do you include the whole seminal vesicles and prostate, or just the whole seminal vesicles? Do you add external iliac lymph node coverage in this scen...

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

68 y.o. Male underwent inguinal orchiectomy and spermatic cord resection of a 5 cm malignant fibrous histiocytoma of the spermatic cord. Margins of re...

Would certain patient/disease characteristics make you choose RT therapy over chemotherapy or other locally ablative therapies? What dose/fraction wou...

What high risk pathology factors would you consider in making your decision one way or another?Would it matter if this patient was elderly vs young? W...

Would you consider post-operative adjuvant treatment more favorable? Does resectability influence your decision? Would grade of the tumor affect your ...

Would your recommendations change if the mass were significantly smaller, say 1-2 cm, and was completely excised with negative margins?  

MRI and cervical biopsy are negative for cervical involvement 

Especially in the setting of prior “standard” adjuvant dose and refusal of the patient to undergo more extensive surgery. Do you recommend...

Burnmeister data from 2012 showed a local control benefit for radiation therapy in selected patients, but that was without immunotherapy. Is adjuvant ...

Do you favor tongue depressor instead? Does this change based on what primary you're targeting (i.e. base of tongue)?

MD Anderson 5 year data was published earlier this year. would also like to know how those who are using IMRT approach planning and constraints.

Would there be a substanital increase in the risk of toxicity using such a scheme?  We frequently have patients who have to travel long distance...

Is this practice still relevant to the modern IMRT approach where skin toxicity is much lower?

Would you require the rituxan to be held prior to radiation?  Would this matter if it was in the post-prostatectomy setting?

Would you consider "neoadjuvant" RT to 45-50.4 Gy followed by a resimulation and a boost to a "definitive" dose of 54+ Gy depending upon disease respo...

What is your normal dose-fractionation in this scenario? Do you change your dosing if the lesion is in a weight bearing structure (femoral head/neck,...

One example of this scenario would be a patient receiving consolidative durvalumab after chemoRT for stage III NSCLC who develops a new peripheral lun...

Did the publication earlier this year by Gundle et al. JCO 2018 (http://ascopubs.org/doi/pdf/10.1200/JCO.2017.74.6941) alter your concept of close mar...

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?

Provided that staging PET/CT showed no residual disease or neck involvement, would you recommend completion surgery and neck dissection? Or do you vie...

Is urgent whole brain radiotherapy indicated for certain histologies such as choriocarcinoma from GTN or testicular origin? If SRS is employed, how sh...

Do you utilize fMRI or other advanced sequences (DTI, etc) in the planning process?  

I've been trained to treat the larger lesion, re-stage, and then treat the other lesion if there are no new lesions (to rule out the possibility of me...

What margins (if any) do you consider appropriate to not require adj RT? And would you ever consider neoadj RT?

Should concurrent chemotherapy be given? How would you modify the regimen in elderly/frail patients?

Our patients seem to hate the 20% benzocaine spray (cherry) saying that it burns and causes their eyes to water. Looking for other options. 

In December 2018, Horn et al reported the results of a phase 3 clinical trial in the NEJM (N Engl J Med 2018; 379:2220-2229). This trial included prev...

Assuming good liver function currently, without evidence for recurrent cirrhosis? Would your decision be affected if it was a primary HCC vs Liver me...

What dose-fractionation scheme do you utilize? Are there particular groups of patients this would not be a good option for (i.e. histologies of diseas...

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

Should cystectomy remain standard of care? (Recently debated in JAMA Oncology: http://jamanetwork.com/journals/jamaoncology/article-abstract/2520055...

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

If you do rechallenge is there anything that can be done to prevent the recall reaction from happening again?

How long after hysterectomy would you consider delivering adjuvant radiation therapy? Would this differ for external beam versus brachytherapy? Are t...

Some specific questions: Would you recommend repeat biopsy to confirm residual disease? How would your recommendations vary if the patient had pre...

Do you recommend definitive therapy? Would your approach change if there are more than 1 site of bone metastases, such as 2-3?

I have seen small amounts of evidence for V4<20cc and V14<7cc, but overall it seems like there is little published on this issue.  

Much of this approach was designed with cytotoxic chemotherapy in mind -- wait "x" cycles, assess response, deliver radiation after chemotherapy. How ...

In a patient with their second cancer, with oligometastatic disease, do the risks of RT related second malignancies outweigh the benefits?

Do you have any specific concerns for patients with implanted intracranial devices?

These patients are often not surgical candidates, but radiation complications may also be underappreciated.  Do you refer to vascular surgery pri...

Is there a role for aggressive surgical resection if the lesions are reasonably resectable or do you prefer biopsy followed by chemoradiotherapy?

How do you surveil or decide to biopsy and treat these additional lesions? Are there certain size, growth rate, or imaging criteria that are usef...

If the breast was previously radiated 15 years ago, would that change your decision?  If there was residual lymphoma on cytology of a chronic se...

If yes, do you have any specific criteria for whom you offer these BID days?

Would you recommend axillary dissection, axillary dissection followed by adjuvant radiation, or axillary radiation alone? Does the number of positive ...

Specifically the groin region? Or are there techniques or a change in the management style of radiation at these sites you would employ to minimize to...

In clinical practice, consolidation chemotherapy is sometimes used, though this was not implemented in the PACIFIC trial. https://www.ncbi.nlm.nih.go...

If a patient had biopsy proven gleason 6 disease 3-5 years ago and has had a slowly rising PSA to between 15-20 over the past year or 2, would you req...

Would this location be adequate for SABR, if so what dose scheduling would be recommended?

Is extrascleral extension or optic nerve invasion an indication?  I can find little in the literature or textbooks discussing this issue, likely ...

Would you recommend RCHOP x 3-6 or RCHOP x 3 + ISRT?  If you end up doing ISRT, would your target be any different than the principles that guide...

What specific technique (i.e. interstitial vs intracavitary, 3DCRT vs IMRT) do you prefer? What do you consider to be the pros and cons with each appr...

What techniques are most effective to minimize contralateral breast, heart, and lung dose? Do you recommend conventional fractionation?

Per the ALSYMPCA study, they excluded patients with > 3cm lymphadenopathy. Patient is currently on Xtandi and Lupron and refuses taxotere.

For instance, in borderline cases for neoadjuvant therapy (e.g. T2N1 disease), should both be obtained to increase accuracy?

This is an uncommon clinical scenario where textbooks suggest to cover the primary tumor and elective coverage of levels II-IV Do you cover any addit...

In a patient with indication for adjuvant radiation (ie. positive margins) after surgery without recurrence, when would you opt for observation only, ...

Would you give chemotherapy concurrently with radiation? Would you change your radiation dose?

Does the STAMPEDE trial, showing a survival benefit with the addition of docetaxel to standard treatment, change the standard of care for high risk, n...

Would you offer definitive management with radiation and ADT? Or systemic therapy alone such as with ADT+abiraterone?

Do you prescribe antiandrogen beyond the typical 2-3 weeks after starting LHRH agonist therapy to prevent testosterone flare? If so, for how long do y...

If so, are there any lymph node cut-offs you would have in terms of lymph node number or pathological ECE before you would add contralateral RT? What ...

Is your scoring based on SUV uptake vs the subjective interpretation of the radiologist? How do you go about reconciling Deauville scoring when there ...

What are the major factors that impact your decision? If you opt for surgery, what factors impact your decision to offer RT preoperatively vs. postope...

Is 30Gy/10fx from the CREST trial standard? Do you ever use a more/less protracted fractionation? Does a malignant pleural effusion at diagnosis affec...

Would you offer palliative radiation? Would you fractionate differently?

What dose/fractionation do you prefer for small vs large metastases?

Are there any quantitative measures that you use to help select patients such as  breast size or heart dose? Or do you use a case-by-case qualita...

Could you discuss how you decide between IMRT or SBRT boost for a patient who is not able to receive intracavitary or interstitial HDR or LDR brachyth...

How should they be prioritized? V10, V12, mean brain dose, prior WB radiation? To what extent should tumor coverage, conformality and homogeneity be c...

Rate of pneumonitis was low in the PACIFIC trial but does it mirror the real world setting? We are seeing increased pneumonitis in our practice.

What factors do you consider in offering adjuvant radiation to the primary and/or elective nodes in nasal SCC? What volumes would you cover?

are there any positive or negative synergies from combined megestrol/RT treatment?

For example in a patient with a good performance status and a biologically favorable cancer (ER+ breast cancer, EGFR+ NSCLC, or prostate cancer), are ...

Some ENTs advocate for a neck dissection as a way to avoid chemotherapy if there is a high chance there is no ECE. This is without removing the primar...

What clinical criteria would make you prefer TORS as the initial treatment approach?  

Would you follow an algorithm such as the one proposed by Hall et al? How do you decide between intrathecal chemotherapy vs systemic therapy with HD-...

Would you proceed with induction chemotherapy (eg TPF or cis/gem) to downstage or neoadjuvant chemoRT? Would your approach be different if there is or...

Degree of subglottic extension is often difficult to determine from office scope examinations and ENTs do not always include this. Do you have any rul...

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...

Should these patients be managed similar to p16 positive anal squamous cell carcinoma, and allowed six months or more for complete regression before c...

Do you feel it is important to start durvalumab within 14 days of completing cCRT?  What real life challenges do you face in doing so and wh...

Does it matter if it's within the treatment area (such as breast cellulitis in a breast patient or a UTI in a pelvic RT patient) or outside the treatm...

Have you seen RAI or lenvatinib be efficacious for locally advanced disease — allowing for better surgical outcomes?  Do you utilize EBRT?

How do you decide?  Do the results of recently published phase III data in the Lancet Oncology (Sun et al, Sept 2016) influence your decisio...

Is there any role for definitive prostate radiation extrapolating from the Stampede and recent RTOG 0521?

Medical inoperability is clearly defined, anatomical resectability is also pretty much clear (invasion of trachea/carina/esophagus, etc). But what abo...

Would you treat to the GEJ regardless of whether the positive node was identified in the upper portion of station 8? Do surgeons routinely dissect to ...

Do you use same contour guidelines of nasopharyngeal cancer? What levels would you cover on the involved neck side? When would you electively cover t...

Do you follow invasive or DCIS guidelines? Would you consider re-excision in a patient with multifocal microinvasive carcinoma of the breast arising i...

Would you consider scrotum contaminated and consider including it in fields?

If so, how do you choose your region of treatment? Dose? And elective nodal volume?

Do you look at max dose or are there specific volumetric constraints you use for the small or large bowel? 

Would you administer extended field radiation therapy?  Would you omit radiation therapy?

Do you fractionate? Do you look at composite doses and/or apply any constraints given the limited data?

What chemotherapy and sequencing with radiation therapy would you recommend? IS surgery a component of the treatment?

Our hospital has an aggressive and talented interventional radiology group. We have wanted to start a stereotactic liver radiotherapy program but are ...

What are your dose constraints for treating axillary nodal basin in melanoma with the Ballo protocol 30Gy/5fx?

Can a second course of SRS be completed? If so, what dose do you recommend?

What is your preferred approach to PMRT with inflammatory breast cancer with adverse risk features (i.e. age <45, close/positive margins or poor re...

For example, when a patient has received 60-70 Gy with concurrent chemotherapy, do you consider dmax, BED, and interval between repeat courses of trea...

The STAMPEDE trial recently published in Lancet used 55 Gy in 20 fractions but did not include dose constraints.

Do you routinely offer post-operative adjuvant radiation in addition to chemotherapy? 

If you are using a standard 30/10 fractionation, is there a benefit to keeping chemo on board for radio-sensitization?

Is SRS reasonable if there is no evidence of more diffuse disease?

Does the update of RTOG 96-01, presented at ASTRO 2015, change your practice for these patients? Or should ADT be limited to a particular subgroup?

These devices give off a significant amount of artifact on CT and some devices say they are a relative contraindication with adjuvant RT.

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

Do you have any preferred dose fractionation schedules? What kind of margins do you use?

What field size and dose/fractionation would you use? Would you treat lymph nodes? 

If so, how would you approach your radiotherapeutic plan and what dose-fractionation would you utilize?

Do you use portal or orthogonal imaging or both?

Do you recommend observation, APBI, whole breast or whole breast with low axilla treatment?  

If clinically node negative, would you add elective nodal radiation?Does it depend on location (upper vs. lower trachea)?

Repeat EGD and additional biopsies of the stomach were all negative for MALT lymphoma and H. Pylori. A CT of the C/A/P was done showing no evidence of...

How does it vary by technique (standard fractionation, hypofractionation, or SBRT)? Does your PTV change if you are treating pelvic lymph nodes?

For example, if the patient has low PSA, Gleason 6 disease but has high volume (>50% positive cores) would that discourage you from recommending ac...

Do you use BID treatments toward the end? Do you add additional daily treatments to exceed the prescription dose? Would you alter systemic t...

SBRT vs more comprehensive nodal RT with SIB to involved node? Would you include the prostate bed in your treatment volume? ADT duration? What other f...

If margins are clear, would this tumor necessitate adjuvant radiotherapy? Synovial sarcomas often occur in a young patient subset, would this cause yo...

Is there a role for an altered fractionation regimen as an organ-preservation approach? This pathological variant is uncommon and the older literatur...

This will influence the decision to operate or not, so you want to give it enough time to see a response, but given that it's a disease predisposed to...

Is is safe to use curcumin during radiation therapy? Is is safe to use with chemotherapy? Do you recommend this? What dose of curcumin is appropriate?...

If so, what patients do you select for the boost? And what data do you give to adequately satisfy the insurance review and win approval?

Would you consider a re-biopsy after chemoRT to confirm viable tumor and if so, how long would you wait after chemoRT before biopsy?  If you did ...

Do you prefer LDR prostate brachytherapy first or as a "boost" following external beam radiation therapy?

The EGFR subgroup appeared not have benefited as much as other patients in the publication. However, recently it was reported that the PACIFIC study m...

Do molecular factors (1p/19q, IDH status) influence your choice of dose/volumes?

Is there any correlation with dose in the area of the phrenic nerve and development of referred shoulder pain and/or diaphragm paralysis?

Colonoscopy reveals inflammation in the colon and rectum due to Crohn's and patient also has perianal fistula due to Crohn's.

Is there a benefit to one fractionation schedule v. the other?

If so, what clinical indications? Are there any advantages of VMAT? Thoughts on concerns regarding lung and heart dose constraints?

What percentage of unresectable T4N0 pancreatic body adenocarcinomas with celiac axis involvement and no response to 6c chemo, will convert to resecta...

Some oncologists wait 1 day, 1 week or 1 month? Is there a preferred waiting period?

Do you insist that the staples are removed prior to sim or do you perform density overrides in the treatment planning system?

Is there a strong rationale for treating the whole prostate (not prostatic urethra) electively to 41-50 Gy?

What size of DCIS would make you concerned? Would you estimate the risk of recurrence with and without radiation?

What's the minimum isodose coverage line you accept for coverage of higher level axillary lymph nodes?

NCCN Guidelines do not address this rare form of H&N cancer. What dose/fractionation would you use for definitive radiation? Is elective nodal co...

Do you find such markers such as biozorb to be more helpful than delineating the seroma and/or clips on CT?   When is this useful? During ...

Is there an age in which you would not offer definitive treatment? How do systemic therapy options, dose, and field sizes change with age of the pati...

Is there an established benefit for this? For instance if your patient has cardiac calcifications on imaging but no history of cardiac disease are the...

Does the T stage influence your decision (for example, T1mic)? Would multiple positive nodes showing isolated tumor cells sway your decision? 

For example, would you go ahead with 20 Gy of ISRT if medical oncology has already treated a stage I-IIA patient with 2 cycles of ABVD meeting all oth...

If all other nodes were negative but the patient was pN2 due to a level 9 LN, what volume would you treatm? 

Do you always recommend treating breast cancer patients with getting reconstruction with their tissue expanders in place? Or is there a scenerio you w...

Per NCCN, treatment options include endoscopic resection (preferred) or definitive RT. The recommended dose is 60.75 Gy in 27 fractions for in-situ vs...

Although these patients are included in the Danish trials, Taghian et al. & Floyd et al. both showed ~ 7% LRR in this group of patients witho...

What dose and fractionation would you use. What is your target volume?

For example, would you modify your SBRT dose next to the azygous vein? While we talk frequently about OAR constraints for the great vessels, it seems ...

For the first treatment day (during combined chemo/XRT courses), is it ok to give XRT first then send the patient for chemo or should the chemo be giv...

I am treating a left lower lobe NSCLC and my PTV is so close to the spleen that a small portion of the spleen is getting significant dose.  I can...

NSABP B-39/RTOG 0413 prescribed a dose of 38.5 Gy using two fractions of 3.85 each daily, but prescribed to the ICRU 50 reference point dose (usually ...

Surgeon is not planning vulvectomy, since biopsies showed 2 mm depth of invasion. Also tumor board felt dose to the primary site should be only about...

Do you use CBCT or kV images? Do you match to the breast or the chest wall?

If they are symptomatic do you relax that time interval? Do you ever consider partial brain radiation instead of whole brain to minimize neurotoxicity...

At what point would you introduce the discussion of weight management, whether for risk reduction or overall health?

Should these patients have surgery if resectable? Should RT (SBRT) be directed at metastases during/concurrently with immunotherapy down the road?&nbs...

In a patient who absolutely cannot receive chemotherapy due to impaired performance status, what dose would you use for WBRT and what dose would you u...

An ASTRO APBI update readers are warned “the combination of IORT and WBI should be used only with caution and limited to women with higher risk ...

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...

NCCN states that daily imaging is discouraged but in practice many radiation oncologists are doing daily cone beam for non-IMRT breast 

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 consider EBRT alone, brachytherapy alone, or EBRT with a brachy boost? Would you counsel these patients differently regarding short/long ter...

I am currently managing two patients (one esophageal and one anal) with this scenario and the referring physicians and patients are reluctant to under...

There have been case series published on this topic (most recently, PMID:26853347) with reported depigmentation within the RT treatment field.

The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...

Assume you have good margins and the cavity abuts the implant. Are there any specialized techniques that you would recommend?

If so, what high risk features would influence your decision? Would + margins, PNI, LVSI etc be reason to treat LN?  If you would treat lymph nod...

The data is scarce- do you recommend chemotherapy only or would you consider RT for local control? 

Do you use NRG/RTOG, IMPORT LOW, single institution data, or retrospective data?

Acknowledging the mixed data, would you feel comfortable that radiation could compensate for the R1 margin? Would you push the surgeons to re-resect?

Please share your tips on dealing with short and long term xerostomia.

As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula? Currently we would recommend esophagea...

If a patient has a metastatic lesion in close proximity to one hippocampus, would you offer sparing of the contralateral hippocampus? Do your dose con...

An example of an air expander is located at: https://www.airxpanders.com/index.php   How do you ensure accurate dosimetry with the use of air ...

If the patient had pelvic adenopathy, would you include that in your treatment volumes?  What dose and fractionation would be considered appropri...

In a stable patient, do you perform standard chemoRT in 2 Gy fractions with IMRT for urgently start with a few high dose fractions (ex 4Gy/fx) and bri...

How do you balance the goal of effective definitive treatment while minimizing the risk of injury to critical structures?

The original study used 50% of positive cores, but the MSKCC nomogram can give a high risk of EPE with just 4-5 positive cores out of 12

Do you modify your dose based on p16 or extent of ECE (e.g. microscopic vs macroscopic)?

Specifically, any data or experience regarding Ehlers Danlos syndrome?

Some emerging data of improved up front therapy shifting recurrence to CNS as sanctuary site, is focal RT approach (i.e. SRS) reasonable or is CSI a s...

Given that it is cleared from the body by renal filtration, are you concerned about clearance issues?

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

Prior trials of systemic therapy including alkylating agents and rituximab have failed and the patient is medically inoperable with no history of Hepa...

For example, in standard high-risk we generally cover proximal 2cm to elective dose, before doing cone down boost to prostate and proximal 1cm. If a ...

The staging bone marrow biopsy was negative. The staging manual simply states "bone involvement is identified using appropriate imaging studies."...

Is there any further benefit of hyperthermia monotherapy, for example, continuation of hyperthermia after the course of radiation has completed?

Are you waiting for final publication of NRG CC-001? If already routinely using, any challenges with insurance approval, plan turnaround time, or oth...

Specifically, is hyperbaric oxygen therapy (HBO) an effective treatment for refractory radiation cystitis?

If considering that it is not gastroesophageal junction, what margin do you place on the clipped GTV to formulate CTV? Is there any role for SIB to PE...

If there was a stage III adeno lung cancer and a contralateral SCC lung primary, what would be the best way to treat?

Do you prefer covering bilateral neck in all cases or do you make exceptions? There appears to be conflicting opinions in the literature: https://ww...

In particular would it affect the decisions for brachytherapy or androgen deprivation? How do you monitor for treatment response since they may not m...

There are data for improved outcomes for inhomogeneous dose distribution in patients with intact brain tumors (Lucia et al, Radiother Oncol 2018), but...

Are there problems with volume changes from the spacer dissolving while the patient is on treatment? What is your department's protocol for these type...

There is no RTOG consensus on boost volume, except to say that it should include the entire mesorectum/presacral region at involved levels + 2 cm in c...

If the patient meets the CALGB criteria for the current cancer, are there situations where you would omit RT in a patient who has never had RT? What i...

Do you have formal constraints and evaluate cumulative doses on the composite plan? Do you use traditional constraints but account for repair? 

Would you recommend mastectomy? What would you irradiate?  What are your fields?

Would you consider treating 3-5mm lesions with SBRT or wait until they are a certain size? I am concerned I will not be able to see them adequately on...

If so, what dose and dose constraints would you consider? How would you counsel the patient about risk of trachesophageal fistula?

Is it sufficient to use fluoroscopy to assess total motion, fuse MRI and PET to create an ITV, and use abdominal compression to limit motion?

Updated NCCN guidelines say there is no data to support radiation for pleomorphic LCIS. Previous discussion recommended radiation for LCIS https:...

If planning standard fractionation, what factors would you consider in omitting a boost (ie age, LVSI, etc)? 

Would you use a similar dose and fractionation as gastric MALT (30Gy in 1.5 Gy fractions)?

Would you recommend empiric diflucan? Would EGD be indicated? At what point would you consider hyperbaric oxygen?

What about in the metastatic and non-metastatic setting, specifically? Any additional treatment (dose/fractionation) or toxicity considerations for th...

After and extensive en bloc resection, is there further surgery that would be recommended? Is radiation alone sufficient? 

What features would make you more likely to recommend radiation therapy with chemotherapy?

https://www.abstracts2view.com/sabcs18/view.php?nu=SABCS18L_568 Any concerns regarding toxicity with APBI?  

Do you use a trimmed 10 mm expansion on HR-CTV? Do you also include the entire initial extent of disease? How much does your IR-CTV coverage affect yo...

Assuming no advanced imaging is available, what lymph node morphologic criteria (ie. lack of fatty hilum, size, number of nodes, etc.) do you use to u...

If a patient's PSA goes from undetectable to minimally detectable (ie 0.03-.05) would you wait to offer salvage radiation?  Would your recommenda...

a. For example, an 8cm rectal GIST that was incompletely excised (assuming the patient will be receiving imatinib). b. Additionally, would you ever co...

No other site of metastatic disease. It is unclear if this situation should be managed as two separate primaries or metastatic disease.

For example, are PET Axumin or PSMA studies being ordered in the upfront setting? 

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

For a patient in the second trimester who wants to continue with the pregnancy, would you consider this? If so, what extra precautions would you take?...

This is a commonly used hypofractionated RT schedule in Canada, but the BED is lower than that for doses used in the US. If so, do you modify your dos...

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 ...

Would you recommend additional surgery for the violated neck? Or, would you proceed with adjuvant radiation therapy? If so, would you treat ipsilatera...

Which risk estimator is felt to be the most accurate and what threshold? What's the best contouring guidelines for ENI for prostate?

What factors influence your choice of SRS vs more fractionated regimens?

What would you anticipate with regard to potential adrenal toxicity when the patient has only 1 functioning adrenal gland? There are no other sites of...

A recent NCBD analysis (Rusthoven et al, JCO 2016) suggests that the addition of prostate RT significantly improves survival compared to ADT alon...

Do your recommendations differ if patients are pre or postmenopausal given the data?

In a patient who has undergone resection and adjuvant chemotherapy who then recurs locally, how would you recommend treating?  Would you treat ju...

Do you prefer WBRT, IT chemo or targeted systemic therapy and what is your preference on the sequence of therapies?

There is no primary and no distant disease seen on restaging PET. RTOG 0236 shows significant regional failure rate. Some have reported salv...

Surgical salvage is indicated but not possible in all cases due to comorbidities or patient preference. Would you re-irradiate and how? Would you co...

Detailed instructions regarding lymph node coverage have been published, but how do you think about coverage of the anastamoses from the gastrectomy?

How do you adequately balance treating a gross retropharngeal lymph node and limiting dose to the carotid? What would you quote the risk of carotid bl...

Do you ever start radiation +/- 24-48 hrs from C1D1 for chemotherapy due to logistical barriers? Do you prefer chemotherapy to start at beginning of ...

If a patient is on rituximab for multiple sclerosis, do you recommend a particular fractionation to minimize chance of MS flare during treatment? If a...

In this case, I have a patient with widely metastatic cutaneous melanoma (BRAF wild type, NRAS mutated) who is progressing through pembrolizumab and i...

Would you recommend a patient get mastectomy to avoid radiation? If treating a breast cancer patient with ILD, what lung dose constraint do you use?

Does EGFR+ status influence your decision? What is the significance of this finding and its potential for progression? Is it simply occult disease con...

In particular, I have a patient who underwent lumpectomy for a T3 tumor with positive margins and 1/2 SLN+.  She is now scheduled for mastectomy ...

Anal cancer guidelines mostly refer to anal canal tumors with less information about tumors of skin in perianal area (ie true anal margin). Would IMR...

If the patient is in remission for metastatic melanoma but continue to take an anit-PD1 therapy, it giving ADT, EBRT + brachytherapy safe for a high r...

What volumes and doses of radiation would you recommend? To what dose would you limit the rectum, especially in a patient with no salvage surgical opt...

Do you consider diversion colostomy, or abdominoperineal resection up front?

For example, do you change your prescription dose, treatment schedule, or OAR constraints? Have you noticed increased toxicity in older patients, e.g....

For example, for the first 25 fractions, you would treat the rest of the pelvis in 1.8 Gy/fx to 45 Gy, and then using a SIB treat the prostate/proxima...

If a patient is due for their yearly mammogram on the breast that has been diagnosed with cancer but is still undergoing active treatment (chemo or ra...

Which appetite stimulants are the most effective? How do you respond to patients who request medical marijuana?

I see the LungTECH trial dose constraints, but, they seem really conservative when you have something large and close the PBT resulting in use of 60 G...

Female in her 60s who had presented originally with well-differentiated endometrioid adeno clinically and radiographically involving bilateral paramet...

For a woman with complete resection of serous intraepithelial carcinoma of the endometrium, would you recommend adjuvant radiation or chemotherapy? Wh...

Should the recent publication of Chen et al. dose escalation study for inoperable SCC esophageal cancer patients treated with CCRT, showing an 8% 5-ye...

How about for non-UIP vs UIP? Non-improvement of ILD with steroids? Specifically in O2-dependent patients? Does the volume of ILD sway your decision (...

What factors would you consider? What if this meant treatment of the full kidney? If treatment is recommended, would you utilize an SBRT approach...

Would an excellent KPS, LVSI+ or poorly differentiated histology change your decision? Would you base your decision on the ANITA trial where subset an...

Since the randomized phase II data from Gomez et al presented at ASTRO 2018 showed a survival benefit, is there concern about randomizing patients to ...

Would you treat these sites to definitive or post-operative doses? If not, is there a dose constraint you use at these sites? Do you use tighter margi...

Would you recommend this for a focally +, diffusely +, grossly + margin? What would you expect local recurrence rate for diffusely (+) microscopic mar...

Does it factor into your decision making in the setting of restricted spirometry and normal lung volumes? Does this differ for SBRT v. chemoRT?

Aquaphor, barrier cream, sitz baths, domboro, silvadene, foam dressings?

Current NCCN guidelines suggest that vaginal brachytherapy is optional, and there may be concern for over-treatment locally given competing risk of di...

Would you do anything different than usual regarding bolus, energies, skin dose desired for post-mastectomy chest wall radiation if a nipple-sparing m...

Is there concern for increased risk of chronic nipple pain with NAC in the boost field? 

Is concurrent chemotherapy necessary for these patients?

The surgical bed created by reconstruction is often quite larger than the surgical bed from tumor resection and neck dissection.  

Does the histology (primary salivary gland vs metastatic squamous from a skin primary) affect your decision making? Any other factors that influence ...

Assuming it has previously been treated with excision and steroid injections? Is it reasonable to treat a bothersome keloid in a pediatric patient aft...

If you would re-irradiate, what dose/fractionation would you use? What systemic therapy would you use concurrent with treatment, if any?

In view of higher risks of rectal cancer after pelvic radiation, is more frequent screening warranted?

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

Do you use a different set of dose constraints for situations requiring treating much of the pelvis, e.g. rectal cancer, versus partial pelvis, e.g. a...

Do you generally always boost the scalp and/or soles even if those sites are not involved with disease?  

Does the lack of D2 dissection automatically necessitate adjuvant chemoradiation therapy (ie <5 LN obtained)? Would the presence of high risk facto...

Would you ever de-escalate your prescription dose in order to reduce cochlear dose when treating younger patients with intact hearing?

 At what energy of electrons would it be better to use photons?  How many fields and what field angles should be used for photon boosts?&nbs...

Does papillary histology influence your decisions regarding surgery, chemo, radiation dose or nodal coverage?

For a patient with cT3-4N0 rectal cancer, does the dose of the previous RT affect your decision making (for example, 45 Gy to the pelvis with boo...

If there is no other evidence of metastatic disease, would you offer thoracic radiation? Either upfront with chemo or after initial system therapy if ...

Would you continue treating the patient (in spite of the risk of causing a frank perforation, sepsis, and subsequently devastating consequences), or w...

Abstract LBA5_PR ‘Radiotherapy (RT) to the primary tumour for men with newly-diagnosed metastatic prostate cancer (PCA): survival results from S...

Node-positive patients were not eligible for ASCENDE-RT, and the current NCCN guidelines do not list brachy boost as an option for regional ...

What techniques have you used to evaluate for field overlap given the different setups? We have used a thick wire placed at midline during the verific...

Would you consider observation following surgical resection with negative margins? Would you recommend WBRT and/or ISRT? What would be your preferred ...

Routinely? Only with oropharyngeal cancer etc.? Given that low expression of EGFR subset did better, do you believe there is a true benefit in cetuxim...

What chemotherapy and radiation doses/fractionation would you use once the airway has been stabilized to provide reasonably safe and effective palliat...

In a patient being treated with a palliative course of radiation for a bony metastasis from lung cancer is it safe to start immunotherapy for POD or w...

Do you consider palliative SBRT 25Gy in 5 fractions? I often find that these patients are in severe pain and my typical regimen is 30 Gy in 10 fractio...

What is the upper limit of size you would consider offering a patient a five fraction regimen?

Do you have a "threshold" quantity/dose of opioids above which you are uncomfortable prescribing?

Would your answer differ based on whether the patient is receiving concurrent chemotherapy? Are there other factors that would influence this decision...

If you use PRVs, how do you adjust their constraints relative to their respective OAR constraint (e.g. do you allow a greater percentage or absolute d...

If so, what dose? What if there is positive a PA lymph node but no signs of distal mets? 

How often do patients become unable to tolerate the dilator during the treatment course secondary to discomfort related to acute toxicity?

Is this recommended in a certain subset of patients (EGFR positive or 1 metastasis only)? Or should we await maturation of the MD Anderson/Colorado/On...

Assume patient is otherwise a suitable candidate.

Would the radiation dose and fields be the same as for squamous cell carcinoma? What chemotherapy would you recommend? 

Is it preferable to do HPV RNA FISH testing or p16 immunostain testing to determine HPV status?  Is one test more accurate than the other? &...

Do you routinely offer definitive head and neck chemoradiation and aggressive local therapies to the oligometastatic sites?

The CROSS trial showed a survival benefit with 4140cGy and concurrent carbo/taxol, but I was always trained to treat to 5040cGy. Is anyone de-escalati...

Patient's with Fanconi's anemia can have severe/fatal toxicity with chemotherapy and radiation but unfortunately can also present with aggressive head...

There seem to be a lot of different fractionation schemes in the literature. Is there one that is most standard?

What factors do you consider when determining this constraint? For example, in a patient who was previously treated to 30 Gy in 10 fractions, how woul...

A case series from Colorado raises concern over significant radiation necrosis with SRS. However, there doesn't seem to be much additional negative li...

On the heels of the discussions regarding skin toxicity prophylaxis and treatment, I am interested in your thoughts and current practice regarding pat...

If a patient has early stage disease with peau d'orange but does not meet criteria for inflammatory breast cancer, is PMRT indicated?

Do you prefer breath-hold techniques (ABC, DIBH) or abdominal compression regardless of tumor motion? Or do you use a general threshold number of cc's...

Should LVI be considered present in a patient with positive nodes? MSKCC showed that LVI is a risk for LRR with 1-3 positive nodes...

Do you prefer to underdose the tumor to meet critical structure constraints such as the optic chiasm? Or to you opt to aggressively treat the tumor an...

Because patients with locally advanced H&N cancers are at increased risk for aspiration, and radiation may increase that risk, some clinicians rem...

The Indiana report and RTOG published a "danger zone".  There was a catastrophic "case report" for 50 Gy in 5 fractions.  Are there alternat...

Would you treat both chest walls at the same time? What fields would you use for the contralateral side:  chest wall and lymph nodes? or just lym...

If so, would you offer pelvic lymph node irradiation in these patients if they have pathologically node positive disease?

Is there an optimal time to give SRS to brain metastases for patients receiving ipilimumab and nivolumab?

A literature search indicates that most port site recurrences are managed fairly aggressively with chemoRT or RT doses 45-66 Gy. This is understandabl...

For a Stage III NSCLC looking to do definitive chemoRT who required IVIG and high-dose prednisone for paraneoplastic myopathy (mimicking dermatomyosit...

Do you change your treatment volumes, particularly when treating the seminal vesicles, to avoid the ureters?

Is there a dose response relationship, as suggested in the phase I MSKCC dose escalation study presented at ASTRO 2017?

At what point would you consider the treatment break to be too long for curative treatment?

For example, in a patient status-post WLE with a close (2.5 mm) deep margin and negative neck node sampling, would clinical (but not pathologic) ...

How do you delineate your treatment volumes? Do you modify your post-treatment surveillance of these patients?

Sequentially or do you integrate the cuff brachy with the EBRT and if so what schedule, BIW, weekly, etc?

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...

With the recent publication of multi-institutional trial data, should this now become standard of care?

Do you have concern for aberrant lymphatic drainage? Do you cover more generously (ie. add IB/V on the contralateral cN0 neck etc.)?

Do you use a specific threshold number of sites to make your decision? Apart from assessing for cytopenias, do you consider any other patient factors?

What would be your preferred management, surgical resection or radiation? If radiation is contemplated, what dose would be appropriate and would HPV s...

Hydrogen peroxide douches? Antibiotics? (If so, what are you covering?) When do you initiate hyperbaric oxygen? Do you find pentoxyfyline helpful? How...

Do you modify your dose/fractionation if the target volume abuts surgically implanted hardware?

What features would help you decide between TACE vs. TARE vs. external beam radiation therapy?

In a patient with a cavitated lesion with underlying chronic infection (identified as cocci) and SqCC, are there additional risks to SBRT? Should spec...

Would you treat this patient any differently than any other very high risk prostate cancer patient?  Are there any additional dose constraints fo...

In patients with aberrant anatomy due to previous surgery with lung PTV overlapping the stomach, how much would you dose de-escalate? Even conventiona...

Would the translocation status influence your decision? Are there specific subsites where elective radiotherapy likely offers a higher therapeutic rat...

In an asymptomatic patient, would this be safe? Is there any reason to withhold radiation such as in case of T1N0 breast cancer advising patient to n...

When you prescribe your dose at 0.5 cm depth of the vagina? For instance, if you measure a vaginal length to be 8 cm, would you prescribe to treat 4 c...

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

Particularly for patients too large for prone breast treatment, do you use a breast immobilization device or bra?   Do you change your fractionat...

If so, what constraint is most clinically relevant? The EORTC LungTech trial (60Gy/8 fractions) does not specify a chest wall constraint. I have...

Would you modify your dose/fractionation dependent upon intracranial control of the primary tumor?

It becomes challenging to keep track of different metastases, especially for patients who have undergone one or more prior SRS treatments.

Do you maximize rectal emptiness at the time of sim (ex with enema if needed) or do you simulate with a full rectum since this is most reproducible?&n...

Do you electively treat nodes and how does your approach change with intra- or extra-hepatic primaries?

Assume your patient did not receive radiation upfront and they had an axillary dissection due to recurrence. Would you recommend radiation? What would...

Would organ invasion (bladder/rectum), size, feasibility of T&O, or size of nodes push you toward neoadjuvant chemotherapy?

For example, would a + vascular margin, extranodal extension of N1 disease, translobar disease, or high risk histologies (large cell neuroendocrine, s...

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...

Specifically, would the addition of a brachytherapy boost impact his ability to receive future intravesical therapy?

The patient had a bilateral orchiectomy (pathology demonstrated no invasion of the tunica) followed by R-CHOP x 6 and IT Mtx with a PET CR in a para-a...

While EBRT + brachy may be preferred, what treatment would you offer if surgery has been performed? What dose and volume of EBRT, brachytherapy, or bo...

Would you repeat PET or is it adequate to change to CT surveillance? Although surveillance PET/CT is not recommended by NCCN guidelines, these are oft...

How do you weigh this concern with the need to prophylactically treat non-involved, high risk para-aortic lymphatics?

Do you discuss this at the first consultation? Is there strong evidence to suggest that risks are significantly increased compared to upfront lobectom...

Aside from Other nasopharyngeal ca patients and those with cancers of the posterior pharyngeal wall, how do you contend with risks of dysphagia w...

Would you use the same schedule as early stage NSCLC primary?

The current NCCN guidelines reserves radiation for patients who are not resectable after induction chemotherapy. Does it make sense to offer concurren...

If the patient is refusing hormone therapy is there a contraindication to prostate RT with concurrent 5FU-based chemotherapy?

Any consideration on standard vs hypofractionation?

Based on the UK OnCoRe matched cohort analysis, would you offer a watch-and-wait approach off protocol or are you uncomfortable treatin...

How high would you extend your field? Would you treat differently if the patient had lower PET avid pelvic lymph nodes?

There has been shifting concerns with medication side effects (such as osteoporosis, blood clots), duration, and potential non-compliance.  

What volumes and dose would you treat? Would you treat the regional nodes alone (including IMN)? Would you treat the chest wall?

What things would you take into consideration for the simulation set-up? Specific instructions for treatment planning? If the PTV is confined to only ...

Many patients are still able to orgasm but are disturbed by the loss of seminal fluid.

If you are treating a very large palliative spine field that encompasses several vertebral levels, would you consider splitting the field (treating ha...

Do you prefer carboplatin-paclitaxel-bevacizumab, carboplatin-pemetrexed-pembrolizumab, or chemotherapy alone?

Would you consider traditional breast doses or higher? Would you consider treating only the axilla if the mastectomy specimen showed widely-negative m...

Would you treat all cases or only select risk factors (T4, N+/ECE, margin+, LVI etc.)?  What would you treat?  Would a negative neck diseect...

Is local control worse for SBRT when the tumor is invading into the bone (rib)?

Would you consider repeating neoadjuvant chemo/RT? Does this, occurring in the context of Lynch Syndrome, change the treatment approach?

The patient is a 75 yo immunocompetent man who has a history of inverted papilloma of the sinuses and presented with a new lesion in the right maxilla...

Would anyone consider elective mediastinal XRT to 45-50Gy then boost involved LN to 60-66? Or treat involved lymph node only?  The patient will r...

The new AJCC staging factors in HPV status and can drastically alter a patients overall stage group, hence dramatically change definitive treatment re...

Do you use size criteria (i.e. bulky nodes over 3 cm), specific adverse histology (adenocarcinoma), or location (near small bowel), etc. 

More recent Italian (Sozzi et al) and French data (Canlorbe et al) show associations of greater tumor size > 25-35mm with higher rates of local &am...

For example, for a squamous cell carcinoma of the forearm treated with Mohs surgery with negative margins, are there features that would lead you to e...

There is a recent publication that nicely summarizes the molecular/genetic tests for prostate cancer (https://www.ncbi.nlm.nih.gov/pubmed/26123120). W...

Per NCCN, only +/close margins and +PNI are given as indications for adjuvant RT. However, are the presence of other risks factors considered to guide...

The NCCN guidelines give the option of "consider systemic tx/RT" for "other factors," what do you consider as other factors? For example: close margin...

If the oropharyngeal cancer is operable (ex T1N1), would would your preference be upfront surgery?   Would you use chemoradiation therapy to bo...

Is MRI fusion is adequate for urethral delineation and sparing?  Would you worry about prostate deformation by placement and removal of catheter ...

Do you always cover these areas of ipsilateral neck is positive? Does it depend on nodal level involved, primary site (oropharynx vs. larynx/hypophary...

A recent phase III trial published in JCO describes the NVALT-11/DLCRG-02 study, evaluating PCI vs observation in patients with stage III NSCLC s/p co...

Specifically, does the Decipher score influence the incorporation and/or duration of ADT? Can it be used to better stratify intermediate risk patients...

Would you recommend only chemotherapy or would you offer chemotherapy followed by restaging and possible definitive CRT and surgery?

Specifically in O2-dependent patients? Have any dose/fractionation regimens been shown to reduce the risk of pneumonitis in this population?

Specifically, in patients who have an undetectable PSA post-op, with high risk features such as seminal vesicle invasion, positive margins, or extrapr...

Using the standard whole bladder dose fractionation used in BC2001, 55 Gy in 2.75 Gy fractions.

For instance: urologists who only refer for a rising PSA, even in a patient with high-risk features, those who use Decipher results to decide when to ...

Given risk of secondary malignancies do you make an effort to avoid/spare the prostate or give any specific dose constraints when treating young men w...

She has extensive colposcopic lesions at upper/mid vagina, but no palpable/visible lesions on standard pelvic exam. Pelvic MRI with 20cc US gel in vag...

I have a patient who will be climbing to the base camp of Mount Everest. Does a climb to 15,000 feet increase her risk? Should she wear a compression ...

Aside from steroids and PT, is there anecdotal evidence for warfarin, hyperbaric oxygen, bevacizumab etc. Any experience with these therapies?

Despite some supportive data, it seems few institutions use these routinely. What do you view as the barriers in their utilization?

PORTEC-3 assigned women with high risk stage I or stage II-III endometrial carcinoma to adjuvant external beam radiation vs adjuvant chemoradiation wi...

Would you offer 3-5 fractions for larger lesions instead or would you favor more traditional standard fractionation regimens?

Based on the updated results of the PCS IV trial is 18 months of ADT the new standard of care for men with high-risk prostate cancer treated with...

I recently saw a patient who had been treated with concurrent pembrolizumab-RT elsewhere. Is this an acceptable practice outside the setting of a clin...

Does it make sense to resect only the axillary nodes, but not the other involved nodal regions?  Regional nodal radiation will be given.  

Would you consider radical cystectomy equivelant in terms of local control and how do you balance morbidity of radiation with morbidity of non-organ p...

If so, do you have specific dose constraints you find reasonably achievable given the difficulties in achieving some of the very low dose goals noted ...

Is there any information on how ADT affects the test operating characteristics?  

Patients are understandably concerned about the risks and benefits of radiation to an oozing, bleeding, ulcerated breast.  

Has your institution changed practice patters based on the findings of the LACC Trial (Pedro et al., SGO in 3/2018) showing worse outcomes with roboti...

Or would you wait to start coincident with the start of cycle 2? If a shorter time from the start of any therapy to the end of radiation (SER) is sign...

Do you routinely pause systemic therapy when administering SRS? Which agents do you view as relative or absolute contraindications with SRS?

Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?

In the context of the new staging systems and possible differences of HPV mediated vs smoking mediated oropharynx SCC, would you ever not recommend co...

Does histology, i.e. urothelial carcinoma versus squamous cell carcinoma, impact this decision?

Will you treat only the anastamosis and remnant stomach without elective nodal RT, or will you include elective nodal RT in your treatment fields, ass...

Would you deliver definitive RT in place of inguinal lymph node dissection in light of new data (PMID: 29336837) In the case of high risk but radiogr...

If so, what fields do you irradiate? The initially involved nodal regions? If not, do you consolidate at any point in the future (ie after a loca...

How significant does the moist desquamation need to be? Does the length of tretment remaining ( i.e. 1 v. 3 weeks) or use of medication effect your de...

Would you include the entire original surgical cavity or only the region of recurrent disease?

For example, a NSCLC of the LLL abutting and potentially involving the adventitia of the descending aorta?

If the cyst was encapsulated and completely removed and SCC was found incidentally on final pathology, what are some factors that would influence your...

Are there any other medications, outside of anticoagulation, that would be considered absolute or relative contraindications?

NCCN guidelines mention EBRT/vaginal brachytherapy as options in addition to chemotherapy in the adjuvant setting for high grade histologies, stages 1...

If a patient is unable or unwillling to undergo dual or tri-modality therapy with chemotherapy or surgery, would you use a palliative radiation treatm...

What if this was an electron vs photon boost? What fractionation scheme would you use?

For a patient with a new contralateral primary or recurrence and previous pneumonectomy, what lung constraints do you prioritize (ex mean lung dose, V...

Is a single-fraction HDR boost appropriate following conventionally fractionated EBRT to 45-50.4Gy?

By the definition this would be M1 disease, but would definitive treatment be appropriate? Is there clear data that a single pleural nodule has no cha...

NCCN lists only substantial perineural invasion.  What about other high-risk adverse features such as histologic subtype, multiple recurrences, d...

Would you use 10 Gy in 1 Gy per fraction as mentioned in a litterature review in Pubmed?

Do you decrease total dose, increase the number of fractions, or both? What factors, in addition to size and location, do you consider?

If a patient has simple bony metastases and no neurologic compromise what are your criteria for recommending that a patient wear a collar for c-spine ...

Apart from H&N SCC, are there times where adding an extra dose of radiation due to a tx break is appropriate?  Is there a decent equatio...

In elderly patients (>70-75) with a good performance status, does the risk of neurocognitive decline outweigh the benefit of PCI?

It seems that we have increasingly been seeing younger patients with breast and rectal cancers.  What rates of radiation-caused secondary maligna...

Has the publication of the recent EBCTCG metaanalysis changed your practice?

What is your preferred dose and fractionation? Do you utilize 4D simulation? Additionally, how conservative are your constraints for ipsilateral uninv...

Is breast conserving surgery followed by radiation therapy an option? 

For example, what is a safe dose for SBRT for a ~5 cm colorectal bone metastasis of the acetabulum?

 How does your fractionation choice change if the lesion is abutting the pleura?

NCCN guidelines lists adverse features as positive margin, but does not appears to include close margin. If felt to be an indication similiar to a pos...

In a patient with newly diagnosed small cell lung cancer with disease limited only to the thorax would you treat with definitive chemoRT in the presen...

If so, how do you quantify this when making a decision about who may or may not be a candidate for SBRT?

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

In a patient with pain that does not respond well to narcotics what would be your treatment approach?  Is there any data that suggests patients c...

If treating the H&N first, would you anticipate some effect of chemo on the rectal cancer?  Would you include 5FU in the H&N chemo for be...

The patient does have significant weight loss, drenching night sweats, but no evidence of other involved sites on PET, thorough skin exam, and has nor...

If the patient is responding to external beam and likely to be converted to resectable, what brachytherapy dose/fractionation do you prescribe and wha...

If the patient has large, bulky nodes would you consider starting after chemotherapy for cytoreduction? Or otherwise consider replanning mid-treatment...

Is conventional fractionation acceptable, or would you use altered fractionation (DAHANCA, SIB, BID etc.)?

What dose would you use?  Would your approach to elective nodal radiation be different in the preoperative setting?

In the case of an excised groin node with no residual disease and no chemotherapy in a young adult patient, how large should the fields be? Is it requ...

Would you take any special precautions with dosing or care for fingernail toxicity?

Inflammatory breast cancer is a contraindication for immediate reconstruction at the time of surgery, but is there a disease free interval after all t...

The reports I've read indicate a fairly high rate of local recurrence and wanted to see if any can give guidance on this fairly rare tumor.

Should any additional anatomical areas be intentionally included in CTV-P2 if it goes beyond the "5+5" expansion? The text (found here:https://www.ncb...

In a patient with high risk rhabdomyosarcoma with significant marrow involvement (Stage IV), who has responded completely on imaging to all known site...

Assuming no distant metastases, should this scenario be managed with "sequential" chemoradiation to the para-aortic region with an external beam boost...

The NCCN guidelines for post-operative RT for Stage I lung cancer with positive margins is PORT to 54-60 Gy (in event re-resection is not feasible). I...

Do you electively treat the tracheobronchial tree? Or a certain length of the trachea and bronchus? Does the volume and dose depend on location (...

If the two intermediate risk factors are on the lower end of intermediate risk (ex GS 3+4 and PSA 11) with a very small volume disease, can a more int...

Differenes in dose of ~3% can be seen between different dose calculation algorithms. What dose calculation algorithm is the best to use? AAA, Acu...

Do you sim and treat with their bladder as is? Or do you have patients who do urinate fill their bladder somewhat? Fluid overload is often a considera...

Is there a role for neoadjuvant radiotherapy prior to attempted embolization or resection? Do you routinely electively cover the location of prior sur...

For HDR brachytherapy for cervical cancer do you use the dose optimization algorithm?  Is there a standard dwell time distribution that should be...

Does your recommendation change if the patient has received prior standard fractionation radiotherapy vs SRS? 

After the publication of ACOSOG Z11 we are seeing these patients in increasing numbers.

For example, assuming an excellent performance status, would you consider local radiation to the primary and metastasis in someone with a single ...

Do patients > 60 years old with no high risk features have any significant benefit? Has the recent update of the EORTC boost trial affected your pr...

What if it was found on SLNB and no axillary dissection was performed? Any risk factors that would make you consider RNI vs CW only vs observation?

In a setting of standard fractionation, we would sometimes consider going to 66Gy total dose to the boost cavity, so how would you "translate" this to...

The recently published SSO/ASTRO/ASCO consensus guideline on DCIS states that "a 2 mm margin minimizes the risk of IBTR compared with smalle...

For conventional fractionation, should one increase total dose above 60 Gy for either close or positive margin (invasive or DCIS). What about for acce...

When would you omit or include a boost for DCIS after whole breat irradiation?

In START B ~ 23 % of women received some form of cytotoxic chemotherapy, and the trial was conducted in the trastuzumab era, but there is no ment...

The Canadian trial showed conventional fractionation might be better in the Grade 3 subset, but this was not shown in the START A/B update. What can e...

Patient had a single 3cm node s/p  excisional biopsy of the one node without nodal dissection. We have done anoscopy and a thorough GYN exam...

When would you favor delivering local therapy (e.g. SBRT) prior to systemic therapy?

Do you follow pediatric protocols or treat this more like a high grade soft tissue sarcoma? Specifically for paratesticular pleomorphic RMS, do you ad...

Would you ever defer radiation in patients with primary brain tumors or would you manage these patients similarly to non-MS patients? How do you ...

What dose calculation algorithm to you utilize (eg AAA, Acuros, etc)? Do you prefer a particular algorithm for certain sites? Do you take in...

5FU/mitomycin C or 5FU/cisplatin? Is there any benefit of cisplatin in terms of skin toxicity?  

Is close margins <=1mm alone enough to warrant adjuvant radiation? What about other factors such as p-Staging, PNI, LVI etc.?

Do you recommend 5FU/mitomycin chemoradiotherapy or radiotherapy alone? What evidence is there for efficacy and toxicity differences between the two ...

Studies have shown increased rate of endocrine dysfunction in these patients: https://www.ncbi.nlm.nih.gov/pubmed/26011172 https://www.ncbi.nlm.nih....

I have a patient with low volume disease of Castleman's disease with cervical lymphadenopathy and tonsillar hyperplasia that is suspicious but not bio...

EBRT boost only? SBRT? If you recommend interstitial brachytherapy do you place needles freehand or with a template based approach?  

If a patient has an increase in PET avidity between the PET/CT done after 2 cycles of ABVD and after completion of chemo, how would you proceed? Would...

Would you treat this as a locally advanced breast cancer and offer surgery, radiation, and systemic therapy? Does your management change depending on ...

Is there any evidence to show that treating with a bellyboard is preferred? 

These patients have been largely excluded from these trials.  What if the infection is well controlled?

When elective nodal radiation is recommended, which nodes would you treat (i.e. facial, pre-auricular, peri-parotid, levels I-III, etc.)?

I trained at a place where use of a bolus for chest wall irradiation PMRT was standard practice, but this is not so at my practice right now.  As...

Assume no history of radiation, no evidence of distant disease and no nodal disease on dissection. Would you treat the chest wall or the&nbs...

In our clinical experience, we have used the treatment planning system's auto-match method, and then manually fine tune adjustments checking skull, IA...

If you are considering chemotherapy and radiation in the definitive, postoperative, or nodal failure scenarios, would you prefer sequential treat...

Is the dose fractionation used in BR-001 (10Gyx3) appropriate for all osseous locations, for example humeral head metastases?

Does your follow-up differ depending on the dose you used (e.g. boom boom vs. 24 Gy)?  Do you routinely image?  If so, do you use MRI or PET...

Would you change your dosing or dosing fractionation (45/25 vs 50.4/28 vs 46/23)? Would you try to adjust your fields?

If the patient received neoadjuvant FOLFOX for 4 cycles then 50.4 Gy with concurrent capecitabine, is that enough treatment to omit surgery?

If so, 50 Gy / 5 fx? 7.5 Gy / 8 fx? If so what dose constraints would you use to help determine fractionation?

Do you refer all patients who are felt to be at high risk to a genetic counselor for testing or are you comfortable performing a MyRisk panel in your ...

What are some guidelines or principles that you use to recommend adjuvant radiation after complete resections of sarcoma? 

Is it better to treat without hormone suppression?  Or would this be reason enough to push the patient toward prostatectomy?

Assuming the patient has N2-3 disease, would you consider omitting IMN? What other techniques would you consider to limit lung exposure?

What would be the appropriate treatment for grade I endometrial cancer s/p TAH/BSO but with SLNB yielding negative nodes. The uterus contained a 2cm t...

If you treat pre-chemotherapy volumes, is there a benefit to induction chemotherapy even in bulky disease. If so, how do you define disease that ...

Would you treat this with whole-abdomen RT with a boost? What dose would you recommend? This would be Stage 1, Group 2 (R1 resection), low risk; but l...

http://www.nejm.org/doi/full/10.1056/NEJMoa1612645?rss=searchAndBrowse&#article_abstract If so, how do you sequence it with adjuvant radiotherapy...

Does fractionation (or location) influence this decision? What is your preferred steroid dose?

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

What factors influence your decision (R1 v. R2 resection? T stage?) If sequential, do you typically prefer radiation before or after chemotherapy?

Is there a role for SBRT to the primary site? Is it required to treat the ipsilateral hilum if no adenopathy was seen on EBUS or PET?

Does the St. Jude's Experience (NEJM 2009, PMID: 19553647) provide sufficient justification for routine omission in high risk patients?

Obviously the details matter a lot, but are there guiding tenets one should follow beyond expressing condolences to the family?

Is there a dose constraint you are using for LV-V5? https://www.ncbi.nlm.nih.gov/pubmed/28095159?dopt=Abstract

At what point would you decide to forego local control managment (RT or mastectomy) in favor of chemotherapy alone?

Given the multiple retrospective studies showing benefit to higher BED fractionation schedules (most recently, http://www.redjournal.org/article/S0360...

Assuming the early stage endometrial cancer was treated with TAH+BSO initially and no further treatment, what would your recommendations be for HGIL? ...

For example, in the setting of a lack of pre-operative imaging, what CTV margin(s) would you utilize for the initial and boost phases of treatment?

Surgery showed 1/5 and 1/4 LNs involved in the groins. What areas would you cover and with what corresponding doses?

What if the patient was not a candidate for additional chemotherapy?  Would your answer change if the patient received the CROSS regimen with <...

In the case where patient history and pathology markers are uninformative to distinguish oral cavity vs oropharynx, do you tend to favor up front surg...

This is a recently described entity with poor prognosis, so even with a CR after RCHOPx6 cycles, is your bias to push for ISRT due to EBV being poor p...

 If so what dose/fractionation? This was reported here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918530/

Given the lepidic growth pattern, do you use similar margins as with frankly invasive lung tumors? Are there any challenges localizing the target with...

How often do you obtain routine imaging if there has been no documented growth after 5 years?

Is the approach chemoradiotherapy (Mitomycin-5FU) as for squamous carcinoma with surgery only for salvage or do you always perform surgery after neo-a...

Assuming you are treating whole bladder only with concurrent chemotherapy, when would you recommend hypofractionated radiation (20 fractions) vs stand...

If imaging is negative for other sites of dissemination within the CSF, do you treat with craniospinal RT or use more localized fields?

This is in regards to the risk of secondary cancers after radiation therapy or cytotoxic chemotherapy (such as anthracyclines) in an immunosuppre...

Would you recommend chemo alone first?  Would you treat with definite chemo-RT to the lung then the head/neck or vice versa? How would this chan...

How would you use the information regarding extent of ECE?  What if the patient was HPV negative?  What is the impact of systemic therapy on...

Would patient age factor into your decision, such as a patient <30 or 40? If you would not give RNI for a favorable pT3N0, are there other risk fac...

CALGB 9343 included ER positive patients but did not separate them out based on herceptin status. Does the study help inform their risk?

When treating lung tumors abutting the visceral pleura/chest wall with SBRT, chest wall or rib pain sometimes occurs. In these cases, I try to avoid i...

For women treated with IMRT, there are multiple ways to define the upper border of the field 1) contouring the PAs up to where the renal vessels exit...

There have been some retrospective studies in the literature describing recurrences in the the site of a temporary trachoestomy for head and neck mali...

Are there special tests you order for SBRT but not IMRT? How does the PSA change differ (if at all) compared to IMRT. Do you still use the Pheonix de...

Would you prophylactically treat LNs as well? Is so, what lymph node regions would you treat if it arose from the sphenoethmoidal recess? 

Patient underwent a shave biopsy of a 6x5x2mm preauricular lesion that showed moderatley differentiated sebaceous carcinoma with deep and lateral marg...

Is it recommended in every pediatric patient?  Are there any guidelines for organ-specific surveillance after XRT for children based on age, dose...

Would you recommend any imaging of the axilla before lumpectomy? Would you recommend standard breast fields vs high tangents to cover the lo...

Would you delay/defer adjuvant radiation and/or temozolomide until completion of IV antibiotics? Would you still treat with a significant skull defect...

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 ...

In the case of patients many years out from RP who have a slowly rising PSA, do you offer salvage RT while the PSA is still very low or follow the PSA...

When would you use EBRT? What dose should be used and what extent of nodal treatment should be included? Is there a tracheal dose constraint?

How would your management change in an elderly patient with no surgery verus superficial parotidectomy or total parotidectomy? 

How does grade, margin status, and previous radiation dose factor into the recommendation? 

For a lesion that appears radiographically consistent with a high grade glioma, would you treat empirically if there is hesitancy to perform a high ri...

If given options of liver, lung, spine, brain, axilla, or other lymph nodes which sites do you pick?

Type II endometrial cancers made up roughly 15% of GOG 249 the study population, but seemed to be balanced between both arms.  Single institutio...

Assume the patient had no radiation, what would your volumes be? Would you recommend radiation if the patient had whole breast/chest wall radiati...

When do you institute a treatment break for skin reaction for patients who receive breast radiation?

In light of the recent consensus contouring guidelines (Soliman et al, IJROBP 2017): 1) Are you routinely expanding along the dura up to 5-10 mm ...

Per the NCCN guidelines, in this specific scenario, adjuvant radiation therapy to the locoregional lymph nodes after lymph node dissection is not indi...

In a patient who received upfront surgery and chemotherapy who later recurred in the regional nodes, s/p lymphadenectomy, would you offer RT?  If...

If workup is negative for a primary lesion, would you consider prophylaxis of potential primary sites (anus/vulva?), and would you treat bilateral ing...

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

Is any further imaging warranted or is clinical surveillance sufficient?  Do you recommend a repeat PET at a year (PMID: 28854069) or beyond...

After whole pelvis radiation therapy, what would be the highest dose you would allow in a single fraction, versus the total course EQD2 for small bowe...

Would you treat if there is active infection?  How much improvement would you expect?

In a clinical N0 patient with high risk (large, deeply invasive, poorly differentiated, +PNI, etc) cutaneous SCC of the head and neck, who do you...

Is concurrent chemoradiation reasonable or excessive in a patient with life expectancy <5 yrs? Should the standard be 5 Gy x 5, and will this provi...

If a patient who has undergone radical prostatectomy many years previously presents with biochemical failure and is found to have a nodule in the pros...

Would you treat if the patient is asymptomatic?  If you do treat, what dose/fractionation would you use?

Is a pleural effusion not oligometastatic by definition? The best evidence for consolidative RT was the MD Anderson/U Colorado/Western Ontario phase I...

Unlike in post-operative cases, you lack detailed pathologic information in this scenario. Do you base your decision on location, size, and/or patholo...

There is anecdotal concern regarding history of estrogen replacement therapy causing stimulation of breast tissue and therefore potentially increased ...

In other words, if there are borderline indications for PMRT (ex initial T3N0 or T2N1 disease) with a pCR, would the suspicious IM nodes lead you to o...

What is the maximal amount of time you would allow between the surgery the start of adjuvant RT? What other factors would you consider when deciding w...

Does it ever differ from a standard rectal field? For example, do you always treat the entire rectum, mesorectum, and entire length of internal iliac ...

The small series by Lowell et al (IJROBP 2011) suggests significant toxicity risks following SRS.

Do you use the typical indications for PMRT (nodal status, size of primary, LVSI, age, etc)?  Or,  do you recommended PMRT more frequently (...

For example, if there was a common iliac node, does external iliac nodal region also need to be included? When, if ever, do you include the exter...

Such as those meeting the eligibility criteria for NRG HN002, <10 pack years, HPV+ T1-2N1-2b, T3N0-N2b

When would you recommend that SLNB be performed prior to neoadjuvant chemotherapy? When would you recommend additional staging (completion axillary di...

How do you deliver it safely? Even when there is adherence to other organs (T4) or positive margins, I'm hesitant to offer RT because the volumes are ...

What is your cavity size/volume cutoff in selecting hypofractionated SRT over SRS?

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

Is there evidence of decreased toxicity in the lung, brain, pelvis, breast or abdomen with 1.8 Gy fractions to justify longer treatment schedules or w...

Would you consider this in a patient with a single omental metastasis found and no other distant spread after surgery?

If the patient had a CR by PET/CT after 2 cycles of ABVD and received 6 cycles of ABVD would you recommended consolidating only the bulky disease and ...

If Dynamic Sentinel Lymph Node biopsy is not available, would you refer the patient for node dissection, radiate, or observe? What nodal regions would...

Is there any evidence that this improves outcomes over a more simple and cost effective follow up of careful physical examination and checking a perio...

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...

In a patient who has a rising PSA, palpable nodule, MRI findings etc., is it ethical to treat the patient with inadequate information and ri...