Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What's the role of contralateral neck re-irradiation in the post-op setting for someone with a remote history of head and neck cancer who underwent definitive RT with elective dose to the bilateral neck now with a new primary s/p surgery with ipsilateral neck dissection requiring post op chemo radiation for bony involvement and ENE?
In a reirradiation setting, I would not offer elective RT. Even if the new primary approached or crossed midline, I would refrain from reirradiating a neck that was subject to prior RT in the 50 Gy range.
How do you manage a seminal vesicle recurrence after prostate brachytherapy?
Finding more of these in the PSMA era. Have managed a few patients with SBRT +/- ADT adjusting dose based on overlapping OAR if needed.
Within what timeframe should adjuvant radiotherapy start for Merkel cell carcinoma of the head and neck region?
I use a 4-6 week post-op timeframe for adjuvant RT for Merkel cell carcinoma. I always prefer closer to 4 weeks, whenever possible.
Is 80 Gy/40 Fx + ADT the new standard of care for definitive radiation of high risk prostate cancer?
For those who want a more thorough answer, enjoy. If you want you can skip to the end for the summary: For well over a decade, we are taught that dose escalation improves biochemical control but not overall survival, while ADT improves both. Do the results of GETUG AFU-18 change this? Let's take a l...
In resected N2 NSCLC, what nodal pathologic characteristics prompt you to recommend PORT?
Increasingly difficult question to answer with the evolution of neoadjuvant and adjuvant treatment paradigms. We know from both Lung ART and PORT-C that the addition of PORT in completely resected patients with N2 disease improves locoregional control across the cohort as a whole; however, this did ...
Do you recommend treating pre-chemo volumes to full prescription dose for locally advanced nasopharyngeal cancer following induction chemotherapy?
I think it is reasonable if the purpose of the chemo was to shrink the primary away from OARs like the optic chiasm. Obviously, as @Dr. First Last says, if the tumor was exophytic, you don't need to treat the air. However, I would still include in my high dose CTV the pre-chemo routes of spread, e.g...
What SBRT dose would you give to a single external iliac lymph node recurrence (1 cm size) for a patient previously treated with salvage radiation to the pelvis?
35 Gy/5 is fairly safe in the re-irradiation setting, and in our experience, it's quite effective for nodal disease.
Would you offer re-irradiation in an adenocarcinoma of the distal esophagus s/p neoadjuvant chemoradiation + Ivor Lewis esophagogastrectomy (ypT3N0) 2 years ago now with TE groove/paraoesophageal LN recurrence with complete response on PET following 8 cycles of FOLFOX?
I generally would offer re-irradiation in this situation. If the lymph node recurrence is completely out of the prior field, it becomes an easier decision and much less technically complex in regard to radiation treatment planning. If out of field, I would treat with 50–50.4 Gy 25–28 fractions with ...
How do you approach cisplatin dosing for locally advanced head and neck SCC in HPV-positive and HPV-negative patients?
Weekly cisplatin 40 mg/m² is not yet considered equivalent to high-dose cisplatin 100 mg/m² every three weeks, and high-dose cisplatin remains the preferred regimen for both HPV-positive and HPV-negative locally advanced head and neck squamous cell carcinoma. However, weekly cisplatin is an acceptab...
How would you manage T3N0M0 sarcomatoid carcinoma of the prostate with adenosquamous differentiation s/p prostatectomy?
Sarcomatoid prostate cancer is an aggressive histological subtype. It may be locally aggressive, and post-operative PSA monitoring may be less helpful for this histologic subtype, which interferes with the usual trigger for initiation of salvage RT (Grignon, PMID 14976541). Despite the lack of high-...