Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is FAST-Forward/ultra-hypofractionation suitable for an early-stage breast patient after a lumpectomy with oncoplastic reduction?
Yes, FAST-Forward is fine after oncoplastic reduction as long as dose homogeneity criteria can be met (V105 < 5%).
What dose and OAR constraints do you use for boost with IMRT or SBRT when a patient with cancer of the cervix is not a candidate for brachytherapy?
Concurrent chemoradiotherapy plus brachytherapy boost (intracavitary or interstitial) is the standard of care in patients with locally advanced cervical cancer. In light of published data suggesting inferior survival if brachytherapy is omitted from definitive treatment, we do not recommend utilizin...
For locally advanced adenocarcinoma of the maxillary sinus, how should the neck be managed?
ENI if high grade
Would you add a brachytheray boost to a locally advanced cervical cancer after surgical resection and pelvic RT?
In general, a brachytherapy boost following external radiation is not standard when treating women for locally advanced cervical cancer post hysterectomy. Neither of the 2 major adjuvant GOG trials (92 and 109) allowed a brachytherapy boost, and even the currently open GOG trial, GOG 263, does not i...
Which normal brain dosimetric constraints are most important when treating brain mets with SRS?
Great point, esp. about the PTV margin issue. Some people argue you don't really need to add a mm or two of margin; "We have sub-mm localization error." A 0.7 mm error in three single dimensions equals a 1.2 mm error for the scalar in 3D (as 1.2 = ((0.7^2)+(0.7^2)+(0.7^2))^0.5), so I think it's a si...
What approach do you take to determine dose constraints for conventionally fractionated reirradiation of the head and neck?
Great question, very challenging scenario.In general, try to minimize the margins for re-RT, and use IGRT, especially if you are close to the neurologic critical structures. (Optics, brainstem, spinal cord, plexus, temporal lobe.)Specific doses and whether you exceed limits: that really depends on w...
Would you consider starting immunotherapy concurrently with whole brain radiation for newly diagnosed metastatic (BRAF negative) melanoma with multifocal symptomatic brain metastases?
This is a challenging clinical situation. In part, the approach depends on the number and size of the CNS lesions. However, I do not recommend the use of WBRT for my patients, as it has not demonstrated a survival benefit. In addition, in the adjuvant trial comparing WBRT to observation, it did not ...
What are the indications for adjuvant radiotherapy for basal cell carcinoma of the skin of the head and neck?
I rarely give adjuvant radiotherapy for resected BCCs because there is little data demonstrating a benefit. For BCCs, with squamous features or nodal metastases, I generally manage as a cSCC. Some reasons to consider adjuvant RT to resected BCC primary tumor might be: -T3/T4 primary (by AJCC 7) -R2 ...
How do you approach treatment planning for lung SBRT in a patient with a lesion within 1 cm of a defibrillator?
V-fib requiring defibrillation poses an immediate life-threatening situation. Even if the patient doesn't regularly need their pacemaker, one would need to know that their defibrillator is functioning. In this case, I don't think there's any choice except to move the pacemaker/defibrillator to the o...
What is your preferred method of surveillance after mastectomy?
The answer depends on clinical circumstances. For all the details, I refer you to NCCN guidelines where this is discussed specifically. However, let me summarize a few key points. Patients are usually seen several times a year for 5 years, less often thereafter. A history and physical exam is always...