Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your regimen for treating a keloid with radiation alone?
Our institutional experience (Hoang, Aesthet Surg J 2017) has largely been with post-excisional RT, although at our institution we have on occasion treated definitively with RT alone. We do not have a standardized regimen for primary RT at our institution and the Malaker et al article is the only pu...
What is the maximum dose to small bowel you would allow in a single fraction with gynecologic brachytherapy?
There is no absolute number, but for a 5 fraction HDR schedule (5.5-6Gy x 5), we limit 2cc to less than 3 Gy and have accepted up to 4 Gy. We make sure that there is no hot spot touching small bowel loop by varying the filling of the bladder and sometimes using a hybrid applicator if needed to try t...
Would you consider partial breast reirradiation in an otherwise healthy elderly patient with a distant history of BCS+RT, now with a clinical stage I triple negative IDC?
In a situation where the patient is declining mastectomy, I would consider partial breast reirradiation per RTOG 1014 while counseling the patient there are limited triple negative patients that have been treated with such an approach.
In which oropharynx patients would you recommend TORS vs upfront RT or chemo-RT?
With MC1675 and ORATOR2 coming out at ASTRO21, and ECOG3311 published shortly afterwards, this topic is now particularly germane. Due to the recent reports on these trials, I'll be writing in the context of possible post-op de-escalation.I think the first and most important question to ask is, "What...
What anal squamous cell carcinoma patients, if any, do you take to 59.4 Gy?
I will not usually treat a patient to over 54- 55.8 Gy. The rate of sphincter dysfunction increases sharply at about this dose level and there is no compelling evidence that higher doses are of benefit. However, for very extensive tumors, sphincter function may be severely compromised at presentatio...
In a patient with very advanced head and neck cancer treated with induction chemotherapy and then definitive radiation do you recommend adding concurrent chemotherapy with the radiation?
Sequential chemotherapy does not provide a survival benefit over definitive chemoradiation. [1], [2], [3]. Hence, reasons to consider induction chemotherapy are for local control of disease and to delay the onset of distant metastases. Additionally, there are concerns for increased toxicity and dela...
How old was the most elderly patient you have successfully treated with definitive radiation or chemoradiation for advanced oropharyngeal cancer?
The timing of this question could not be more fitting, since I am currently treating a 97 y.o. gentleman with radiation therapy for his HPV-associated oropharyngeal cancer. Upon his simulation, my therapist and nursing staff gave me a hard time for even offering the patient any cancer treatment. Lit...
What pulmonary dose constraints do you use for patients undergoing lung SBRT for metachronous or recurrent disease after definitive chemoradiation?
Re-irradiation for lung tumor is an area of growing interest. Most of the data is based on retrospective series from single institutions so we don't have a standard to go by. The most important issue is patient selection. The largest risk is pneunonitis. Reported rates from MDACC, MSKCC and Louisvil...
How would you manage a middle thoracic esophageal squamous cell carcinoma (tumor is 25-30 cm from carina) with a positive supra-clavicular lymph node?
For Proximal/Mid Thoracic ESCA, supraclavicular node is considered a regional node, and therefore part of the AJCC N1-N3 staging system, and should be managed with locoregional treatment, using preoperative or definitive chemoradiation, to 50-50.4 Gy in 2.0/1.8 Gy per fraction. The node could be tre...
Do you recommend adjuvant ADT instead of neoadjuvant ADT with prostate RT?
If ADT and RT are synergistic rather than additive, then the sequencing of therapies should matter. Neoadjuvant: ADT has been shown to reduce proliferation and cell cycling (increase radioresistance) and decrease hypoxia (increase radiosensitivity). However, tumor hypoxia is not a major driver of ou...