Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend post lumpectomy RT in an elderly woman with a T1N0M0 stage breast cancer ER/PR/HER2 positive?
As your question states, neither CALGB 9343 nor the PRIME II study assessed HER2 status of its patients as both of these trials commenced prior to the routine testing of HER2 status. So we cannot glean any information from these randomized trials of the omission of radiation in the ER+ HER2+ patient...
Is it safe to offer SBRT for a secondary NSCLC after breast or chest wall irradiation many years prior?
I agree with @Dr. First Last. Surgery is preferred here. However, if surgery is not an option or is high risk, I would offer SBRT. I still offer 10 Gy x 5 in this setting because if I do it, I still want to offer the best chance for tumor control (10 Gy x 5 has a BED10 = 100 Gy, the threshold dose)....
Would you consider moderate hypofractionation for men with large prostate (>100cc) and poor AUA/IPSS score?
Size of the prostate, per se, is not a contraindication to moderate hypofractionation, if you can meet your dose constraints. However, I am much more concerned about a poor AUA/IPSS score when recommending radiation. I prefer conventional fractionation EBRT in these patients. In my experience, their...
For treatments using thermoplastic mask immobilaztion, when supplemental bolus is needed, what is your method for ensuring reproducibility of set-up and bolus effect efficacy?
In most cases, my bias is to place under the mask, so that I am more confident that bolus is flush against the skin and there is less room for airgap in the event of anatomic change / weight loss. For areas of bony prominence (scalp, cheek, etc.) in cases where weight loss is not expected, placement...
How has advanced imaging, especially PET/CT, changed your treatment volumes and approach for a head and neck cancer of unknown primary?
PET may identify contralateral positive nodes that were negative or borderline on CT and distant Mets not appreciated on chest CT. These account for a small proportion of patients. The false positive rate in the oropharynx is about 35% so not much help there. So, in general, no.
How do you manage/treat acute radiation-induced enteritis?
I have no problem with the excellent comments already made. However, I think it is important to add some comments. First - one needs to be sure that the patient truly has radiation enteritis. Many patients receiving abdominal radiation therapy have other issues that need to be explored first. For ex...
How would you approach retreatment of a small central lung lesion after an infield recurrence within the high dose region after conventionally fractionated chemoRT?
There aren't any good established dose constraints in this reirradiation setting. Pertinent open issues include the specific role of time in recovery of the bronchus and other central structures (e.g. what is the time threshold at which retreatment becomes more safe?) and the impact of combining dif...
Do you prefer to use the FAST or FAST-Forward regimen when treating stage I breast cancer with an ultra-hypofractionated approach?
We favor APBI like the Florence regimen but if technically not suitable, then FAST-Forward.
What bowel dose constraints do you use when treating bladder cancer with moderate hypofractionation?
Two additional steps I take when using hypofractionation doses as noted above is to 1) ensure that the V55 Gy to small bowel is limited to less than 5 cc (based on some data in gynecological cancers) and 2) make sure the full thickness bowel loop is not in the PTV2 volume.
How would you approach a patient with metastatic breast cancer with extensive skin involvement?
The issue of extensive skin involvement in metastatic breast cancer can be very challenging. Many factors come into play including whether the patient has had a mastectomy or has an intact breast as well as whether previous radiation has been delivered. For a previously untreated intact breast: Sur...