Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you add a third field for IMPORT-LOW style partial breast irradiation?
I don’t usually use the 3rd field and treat with min tangent with FIF to improve homogeneity. If planning to do conformal RT then prefer an APBI dose of 30 in 5 with VMAT technique.
What is your approach for a primary tracheal squamous cell carcinoma?
First off as you probably know this is a randomized data-free zone. So to some extent what to do here is empiric and/or based on historic outcomes, retrospective data, and so on. But here are a few quick & dirty observations...1) Surgical patients have the best survivals/outcomes. Doing tracheal sur...
What is the current paradigm for breast cancer diagnosed with isolated metastases prior to initial treatment?
Surgery of the primary did not significantly improve overall survival in which patients were randomly allocated to receive systemic therapy alone or (for responding patients) to systemic therapy followed by primary tumor resection in the trial conducted by ECOG-ACRIN (Khan et al., PMID 34995128), at...
What constraints do you use for the BID small cell lung cancer regimen?
The best validated constraints are from CONVERT (CALGB 30610/RTOG 0538). Cord D0.1cc < 41 GyEsophagus mean < 34 GyHeart V60 < 33%Heart V45 < 67%Heart V40 < 100%Lung V20 <40%Lung mean < 20 GyAlthough I tend to push for the LU005 constraints which I think are slightly more conservative.In addition to ...
Are there reasons to not use prostate SBRT when treating the prostate +\- proximal SV?
Early trials such as HYPO-RT-PC which aimed to validate a 7-fraction SBRT dose schedule by comparing it to the standard of care at the time, conventionally fractionated EBRT, utilized a treatment volume consisting of the prostate alone without the seminal vesicles (SVs). While there was some suggest...
What is the optimal duration of ADT for unfavorable intermediate risk or high risk localized prostate cancer treated with SBRT instead of conventionally fractionated or hypofractionated RT?
There is no available data from randomized trials to support any modification in the choice of ADT (GnRH agonist vs antagonist) or use of abiraterone acetate, or on the duration of ADT (4-6 mo vs 2-3 years) based on the form of radiation, and thus I follow the NCCN guidelines that provide recommenda...
For a cutaneous malignancy near the eyelid, how do you decide whether to use an internal eye shield or an external eye shield during treatment?
If the target is the eyelid, then use an internal eye shield.
Would you consider neoadjuvant chemotherapy for patients with muscle-invasive bladder cancer who are cisplatin-ineligible?
We have level 1 evidence supporting neoadjuvant cisplatin-based chemotherapy followed by cystectomy, there is no evidence supporting non-cisplatin based chemotherapy. Patients unfit for cisplatin should proceed directly to surgery.
What volumetric dose constraints, if any, do you use for the mandible in the definitive setting for H&N cancers?
The planning directions for the mandible are typically <50 Gy. However, when the targets are adjacent to the mandible we do not constrain the maximal mandibular dose if it may compromise target dose. In that case, we plan a dose gradient across the mandible, with the mucosa and inner plate of the bo...
How would you treat a biopsy proven isolated left-sided internal mammary node recurrence 20 years after mastectomy and chemotherapy for left breast cancer?
A 20 year truly isolated IMN recurrence sounds like a pretty good example of an oligorecurrence to me… I think the historical standard of care is definitely as @Dr. First Last and @Dr. First Last have outlined above, but I wonder if it’s time to start viewing a locoregional breast oligorecurrence in...