Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What time frame, number of PSAs, and calculator do you use for calculating PSA doubling times?
I typically use only values of 0.10 ng/mL or greater, and at least 3 separate PSA values that are at least 3 weeks apart from each other. The greater the number of PSA values, the more accurate the PSADT calculation will be. I like to use the MSKCC calculator: Prostate Cancer Nomograms: PSA Doubling...
In a patient with a small cell of the esophagus in which trimodality therapy is planned what dose of preoperative radiation would you use and would you utilize BID fractionation?
As is the case with many rare histology malignancies, there is no standard therapeutic approach to the management of small cell carcinoma of the esophagus. Nevertheless, there are small institutional experiences published on this topic to help guide decision making. Since the question refers to a pl...
How would you approach treatment of an elderly patient with recurrent atypical fibroxanthoma (malignant spindle cell neoplasm) after Mohs surgery?
We published our experience of 8 cases of scalp atypical fibroxanthoma treated with XOFT 50 KeV photons as primary therapy. At 24 months, there was one failure which occurred in the only patient who was not debulked prior to radiation therapy.Treating with low energy photons or electrons after the r...
How do you treat the chest wall after mastectomy with an expander?
We have not been treating patients with immediate tissue expander reconstruction with hypofractionated photon post-mastectomy radiotherapy off trial. However, we are excited to be opening @Dr. First Last's A221505 randomized photon study. In addition, we are nearing completion of enrollment to NCT02...
Would you recommend radiation or chemoradiation in a patient with cholangiocarcinoma s/p surgery and adjuvant treatment with single hepatic metastasis 3 years later?
Challenging case and worthy of tumor board discussion. I would likely start systemic therapy, and if response, consider regional therapy with resection or SBRT, assuming the hepatic function is adequate (keep in mind, TARE can cause liver disease). I have one patient in a similar situation, now > 5 ...
Should capecitabine be administered at a specific time prior to RT in pre-op chemoradiation treatment for rectal cancer?
We looked at this question and published our analysis in 2007. We looked at the timing of administration and radiation delivery. The dosing of capecitabine was standardized, and the radiation timing was random. The 2-year local control, distant control, and disease-free survival were nearly identica...
Which patient subgroups do you plan to omit regional nodal irradiation for, given the publication of NSABP B-51?
I will await more data with subgroup analysis prior to changing my practice pattern.
Would you offer SBRT as an alternative to surgery for an atypical carcinoid lung tumor?
As this question pointed out, small series do show a likely benefit to SBRT for an inoperable atypical carcinoid. Two general points to make here. First, RT has been used for many years to treat atypical carcinoids when the tumor or patient characteristics don't support surgery. Second, we treat man...
Do you use any dose constraints ovaries/uterus in premenopausal women receiving pelvic RT and hoping to preserve fertility?
For ovaries I use the principle of as low as we can achieve based on CTV and PTV. If possible have used number of 5 Gy or below. Based on ovarian ablation studies for breast cancer 15-20 Gy would ablate ovaries
Are there guidlines for elective coverage of nodal basins in head and neck for skin cancer removed in the area?
Practically, I find the following tool from Aukland very helpful.They mapped melanoma lymphoscintigraphy data onto an interactive tool that allows you to select different locations and estimate the nodal drainage. https://sites.bioeng.auckland.ac.nz/hrey004/head/ https://sites.bioeng.auckland.ac....