Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When treating a low-lying and bulky cT2N0 rectal adenocarcinoma invading the anal sphincter muscles with neoadjuvant chemoRT for downstaging, would you electively include the inguinal lymph nodes?
Based on the paper that we published at MDAnderson in 1990, the inguinal recurrence rate is 2 to 5% if they are not treated electively in patients with tumors involving the anal canal. If the tumor is within 2 cm of the anal verge or right at the dentate line, it was 5%. If the tumor was between two...
When would you offer post-operative concurrent chemoradiation in anaplastic thyroid cancer?
The management of ATC has evolved considerably over recent years with the most significant being a dichotomy of management based on Braf mutation. We typically offer postoperative XRT, including in patients with either a limited or stable DM disease. However, in a multidisciplinary setting, there so...
Would you consider using LDRT for joint pain/arthritis caused by aromatase inhibitors as a means to keep patients on therapy?
I would try this. I think there is an inflammatory component to this, and the subjective complaints appear to mimic OA. However, I do think this would be a wonderful group of patients to try this on. They are probably already comfortable with radiation, the achiness/discomfort from ET is real and we...
What target volumes do you use for rectosigmoid/very superior rectal cancers?
The simple answer is that there should be a major alteration in treatment volumes in these patients, as there should be NO target volume as most of these patients with very high rectal/rectosigmoid tumors do not need to be irradiated at all. If one looks at failure patterns, the risk of local failur...
In what situations would you treat a rectal mass as cancer despite negative biopsies?
It is not uncommon to see a patient with rectal mass highly suspicious for malignancy by endoscopic evaluation but has a negative biopsy. Usually, this is due to superficial biopsy specimens. In our clinic, we usually get repeated endoscopic evaluation with biopsy as our first step. However, a small...
What dose constraints do you use for RCC/Kidney SBRT?
As is often the case, there is no single answer to this question, and the ALARA principle should always be kept in mind. A good starting place to determine your OAR constraints for a given case is to consider the clinical context. Ultimately, in deciding on allowable OAR constraints, one has to cons...
How do you manage rectal wall infiltration during a rectal spacer procedure?
At ASTRO 2023, PACE-B reported RTOG grade 2+ GI toxicity was exceedingly low at only 1/348 for 78 Gy/39 fx or 62 Gy/20 fx and only 1/363 for 36.25/5 fx. Anyone know what % of patients in PACE-B had SpaceOAR or similar products? This raises the question of whether SpaceOAR or similar products are nee...
Is there any threshold regarding extraprostatic extension to contraindicate a rectal spacer?
This is an important question, and as far as I know there are no data to guide a response. I personally believe that EPE (within reason) is not a contraindication to hydrogel. One would expect the extension, capsule and prostate to lift in unison, depending on where the extension is. The NCCN guidel...
How would you manage a high grade acinic cell carcinoma of the parotid with isolated recurrence in the ipsilateral neck s/p salvage resection?
For this patient with a neck recurrence and (presumably) no evidence of primary site recurrence who had been treated with RT previously to the parotid bed, I would treat ipsilateral neck levels IB, II, III, IV, and V. While IB coverage may be controversial, if the recurrence was in level II, I would...
What are the indications for adjuvant radiation for a resected acinic carcinoma of the parotid?
Although considered low risk, acinic cell carcinoma may be unpredictable. I would add postop RT for very close margins. PNI would depend on extent of nerve involvement. I would if it was extensive. I would not for LVSI. I would in the unlikely event of positive nodes.