Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you consider preoperative chemoRT v. chemotherapy in unresectable thymoma or thymic carcinoma?
I believe that the best systemic therapy for thymoma is anthracycline-based (e.g. cisplatin, doxorubicin plus cyclophosphamide (PAC)) as these regimens have historically about a 20-30% higher response rate than non-anthracycline regimens. As such concurrent radiotherapy is not permissible because of...
What are the most common errors that can be made when performing prostate SBRT?
For those that are developing a Prostate CyberKnife Program:1. Fiducial placement: The fiducials should be clearly separated on orthogonal X-ray images. See our paper for one strategy: Lei S et al. (2011) Frontiers in Radiation Oncology2. Treatment planning MRI: Make sure the MRI-CT fusion is accura...
Do you include the anterior fibromuscular stroma in your prostate CTV volume when using MRI fusion?
Yes, I do. The standard CTV for definitive RT for intact prostate is the entire prostate. The anterior fibromuscular stroma can be involved by cancer. The negative predictive value of MRI for this area is not perfectly understood, so I stick with the standard volumes until we have better data to gui...
How do you treat a parotid Warthin's tumor in a medically inoperable patient?
By "medically inoperable", I would assume life limiting co-morbidities and/or poor KPS. In this situation if the tumor is asymptomatic (and only incidentally detected), I would not offer any treatment. Given that Warthin's tumors have an indolent natural history, it would be analogous to an indolent...
When (if ever) do you consider radiation therapy as adjuvant treatment for GIST?
I would NOT consider radiation as adjuvant treatment for GIST. A diagnosed GIST tumor is standardly treated with Imatinib as medical therapy in the first line. Resistance to Imatinib or genetic variations may cause slight modifications to this therapy, however I have not used RT in the adjuvant sett...
What is your dose-fractionation for cylinder-based vaginal cuff HDR brachytherapy for an isolated vaginal cuff recurrence after whole pelvis EBRT with residual thickness of disease <5 mm?
I usually prescribe 5Gy x5. I don't prescribe to a fixed thickness but treat based on residual thickness seen on MRI using multichannel applicator.I lesion at apex then treat upper 2-3 cm of vagina Here is out paper describing technique and outcome in detailhttps://www.ncbi.nlm.nih.gov/pubmed/299299...
What dose do you use to palliate multiple myeloma in a vertebral body?
For ISS Stage 1 MM patients who are going to have an OS of over 10 years, I generally prefer a more protracted regimen of 25 Gy in 10 fractions for improved durability of pain control. I typically only treat the symptomatic VB only and use inverse planning. If there is gross epidural disease or cord...
What urethral dose constraints would you use off-trial for reirradiating the prostate using SBRT?
The short answer to this question is that there is no evidence-based answer. Below is a review for anyone interested. Background: The recognition of local recurrence as a pattern of failure seems to be growing, perhaps in part due to the increased utilization of advanced imaging (as previously discu...
Does your choice of dose and fractionation for bone metastasis depend on the location of the metastasis in question?
Actually, at this point, I've pretty much gone to 400 cGy x 5 fx for most everything, with the exception of really nasty disease where I might do an SIB to the GTV to 500 x 5 while the PTV gets 400 x 5, or someone going straight from XRT to hospice where I'd give 800 x 1. I still have a gut feeling ...
Are there any special treatment considerations when treating a patient with laryngeal cancer with significant Reinke's edema of the vocal folds?
If possible, I would collaborate with the ENT/ORL who diagnosed Reinke's edema. Reinke's is often from smoking and then I'd counsel smoking cessation. Sometimes it can be from reflux or hypothyroidism - so treat that if that's the issue. I would also be sure you are confident of the local extent/sta...