Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you adjust your CTV for a locally advanced rectal cancer case with invasion of the prostate?
I’m not aware of any “high level” guidance on this specific question. Most cases I see have limited invasion of the peripheral zone of the prostate and/or seminal vesicles. With the assistance of a registered MRI, I contour the gross primary tumor and add at least a 1 cm margin into the prostate. I ...
How would you treat a carcinoma in situ of the larynx with involvement of the false cord and arytenoid mucosal surface?
63 Gy/28 fractions larynx only
Would you offer hypofractionated PMRT to a pathologic T2N1a BRCA positive patient?
I would irradiate this patient due to the combination of a positive node and LVI, regardless of her age. I define "young" as age 40 years or younger; others use age 35 to 45 as cut-offs. It's not clear what this patient's age is based upon the information given.All of the data to date from randomize...
Is there a chest wall constraint you typically use for 60 Gy in 15 fraction NSCLC treatment?
We generally keep chest wall Dmax <110% and keep as much 105% out of the chest wall as possible, with a very low-priority goal of V4000 cGy <30 cc. I am definitely not strict about this in most cases, especially the volumetric goal.
What dose would you use for a plaque brachytherapy for a melanoma involving the iris?
The following isotopes have been used for radioactive plaque therapy to treat choroidal melanomas: 125I, 103Pd, and 131Cs as low-energy seeds, and 106Ru as β emitter. The dose used for uveal melanomas is between 80-90Gy with most studies reporting doses ~85 Shields et al., PMID 10980767. In this lar...
For esophageal and gastroesophageal junction cancers, which lymph nodes are metastatic versus regional?
I would say the short answer is no, hilar nodes are not regional nodes for esophageal of gastroesophageal junction cancers. The long answer would require a definition of what we're talking about when we say lymph nodes are "regional". This may have different definitions depending on the setting. F...
What BED10 do you aim for when prescribing hypofractionated treatment for ultra-central tumors of the lung?
BED10 (3) for the regimens listed above (and a few others) 50 Gy/5 fx: 100 Gy (216.67 Gy) 60 Gy/8 fx: 105 Gy (210 Gy) 70 Gy/10 fx: 119 Gy (233.33 Gy) 62.5 Gy/10 fx: 101.56 Gy (192.71 Gy) 60 Gy/15 fx: 84 Gy (140 Gy) 72 Gy/18 fx: 100.8 Gy (168 Gy) 77 Gy/25 fx: 100.7 Gy (156.05 Gy) 79.5 Gy/30 fx: 100.6...
Is there any evidence that radiotherapy can worsen balance, dizziness, or vertigo in patients treated for vestibular schwannoma due to transient edema?
While the answer from Dr. @Dr. First Last addresses a much broader category of patients treated with SRS, we have looked specifically at post radiation side effects after treatment of vestibular schwannomas treated with either SRS (12.5 Gy), hypofractionated SRS (hSRT with 5 fractions of 5 Gy), or c...
What is your cochlear dose constraint when treating acoustic neuromas with SRS in a patient with intact hearing?
The critical components of hearing susceptible to radiation toxicity of vestibular schwannoma treatment include acoustic nerve, cochlea, and brain stem. It is unclear which structure is responsible. It helps to understand the continuum of fibers from the endolymphatic receptors from cochlea to form ...
What are the common side effects that you observe with TTFields?
I think most patients do tolerate TTF. I’ve seen patients with concerns of skin irritation, but I think the bigger issue is the inconvenience and aesthetics.