Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a correlation between rectal cancer stage and dose response to radiotherapy?
Possibly. While some compelling data from Appelt et al. in 2013 reflected there may be a correlation between RT dose and rectal tumor response (Appelt et al., PMID 22763027), an extensive number of prospective trials examining the influence of boost doses of RT on pathologic response have produced m...
What is your preferred treatment for Stage IIA seminoma or IIB seminoma with LN <3 cm and normal tumor markers after orchiectomy?
Para-aortic nodal disease <5 cm is well treated with radiotherapy to PA+pelvis with boost tot eh nodes with high cure rates and minimal toxicity. >5cm best treated with BEP or EP chemotherapy. No role for RPLND in seminoma.
Are you altering your use of Active Breathing Coordination for breath hold technique patients in light of the COVID-19 pandemic?
We use DIBH, and this has not changed anything in our practice.
Would you offer adjuvant radiation to a large solitary fibrous tumor of the lung s/p wedge resection with close margins?
If a benign SFT, I'd observe. If malignant, I'd consider 50 Gy/25 fractions to the surgical bed. The role of adjuvant radiation isn't well established, with some small reports suggesting LC benefit with tumors >5 cm and/or positive margins. Given "large" and more limited surgical resection with wedg...
Is there a role for adjuvant chemotherapy and/or immunotherapy for early stage, N0 non-small cell lung cancer treated with SBRT alone?
Excellent question. There is certainly a need! If we step back and take an honest look at our control rates with SBRT, while primary tumor control rates are high, we suffer the same viciousness of lung cancer that surgeons do - local control is trumped by a 2-3x rate of regional and distant failure....
When treating the whole brain with hippocampal avoidance, do you ever deliver SIB to gross disease?
There have been several papers and an ongoing trial evaluating the safety and efficacy of including SIB to macrometastatic disease with HA-WBRT. A recently published trial from the UT-Southwestern team was a single-arm phase II trial, which treated 50 brain metastasis patients with HA-WBRT to 20 Gy ...
What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?
Patients with stage I rectal cancer treated with organ preservation require close surveillance to rule out tumor regrowth and local recurrence that may be salvaged with radical surgery. The highest risk of recurrence is within 2 years after completion of neoadjuvant therapy and patients should be fo...
What are fractionation options for a patient with progressive jugular foramen paraganglioma now causing multiple cranial nerve deficits?
I typically individualize fractionation based on tumor volume, proximity to brainstem and cochlea/IAC (especially when serviceable hearing is present), and the pattern of cranial nerve deficits. For tumors <35 cc, I favor SBRT 24 Gy in 3 fractions, with escalation to 27 Gy when aiming for maximal tu...
How are you using the Decipher score in the definitive setting for prostate cancer?
This is an excellent question.Before I can answer the question directly, you must ask yourself: how do you currently decide who to give ADT to with RT?The easy answer is that you use RCTs to choose who to give short-term and long-term ADT to. However, I wish it was that easy.Lets take RTOG 9408- It ...
How do you deal with an interruption in definitive EBRT for prostate cancer?
The evidence that total treatment time matters in prostate cancer is pretty weak. In general, I would proceed as planned when the patient is able to resume without increasing the intended total dose. In this case, I would prefer not to stop at 60 Gy, as that dose probably would not be curative. Unle...