Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can you re-treat vertebral metastases with SBRT?
I typically utilize the same prescription doses in the upfront and re-irradiation setting. The difference is typically in my cord constraint (and in effect the coverage of the target). In regards to the spinal cord constraint, I typically allow a cumulative BED3 of 70-75 Gy to the cord plus 2 mm acc...
In what clinical situations do you order NavDx?
At MSKCC, we largely use NavDx as part of our post-operative de-escalation trial in which NavDx is checked pre and post surgery to help select patients for de-escalation. If NavDx becomes undetectable after surgery: In patients with pathologic risk factors that warrant adjuvant RT, patients undergo...
How would you manage a POLE mutated, p53 abnormal IA myoinvasive carcinosarcoma of the endometrium with no LVSI?
I would not change the management of IB and above non-endometrioid histology based on mutation analysis as almost all data is for endometrioid histology.
What dose constraint, if any, do you use for the ureters during prostate radiation?
I have never changed the treatment volumes or applied a specific dose constraint. The ureters can sometimes be hard to see on CT, but contrast helps and this is something we don’t routinely do. The vas deferens is another structure we tend to ignore too. I think this will be an increasingly importan...
How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?
With respect to working up the enlarging lymph node, I agree with @Dr. First Last and @Dr. First Last above. If confident that this is seminoma recurrence, tumor markers normal, and if stage IIA or select stage IIB (select non-bulky, <=3cm) cases, our team advocates for radiation to the para-aortic ...
How do you manage disease progression during adjuvant chemoradiotherapy for glioblastoma?
Hospice.
Do you ever consider a dose constraint to the spleen when treating lung tumors with stereotactic radiotherapy?
Spleen-schmeen. :) Which is a non-professional way so say I think it’s okay to treat it. If you consider we used to remove them for Hodgkin Lymphoma, they are important organs but not crucial. If you’re treating a corner of it (which I have done many times) you will be safe IMO. It’s not hollow visc...
What factors would make you consider adding adjuvant radiation to the neck of H&N cancer after a negative dissection (pN0)?
If there is an indication for adjuvant radiation therapy based on NCCN defined "adverse features", I include both the primary site and the neck even if pN0. It is never possible for the surgeon to remove ALL the lymph nodes in the neck and there is always risk of microscopic involvement of the undis...
Do you have any normal tissue constraints for endometrial cancer patients receiving EBRT and vaginal cuff brachytherapy?
We use following constraints for EBRT35 Gy to less than 35% of bowel bagRectum 40 Gy less tha 40-60% Bladder 40 Gy less than 40-60%Bone marrow ( pelvic bone) V20 less than 75% Femoral heads V35 less than 5%for brachy as adjuvant we give 5 Gy x2 to thickness of vaginaSince total dose loss limit and p...
What approach have you found works best in treating persistent acute radiation proctitis in patients undergoing pelvic EBRT?
Obviously, this is an important question, though I'm a little unclear on the meaning of "persistent acute" radiation proctitis. Though I am not certain, I believe @Dr. First Last's answer applies more to chronic (or at least sub-acute) radiation proctitis. As for the more traditionally "acute" radia...