Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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 ...
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...
What are your top takeaways in Head & Neck Cancers from ASTRO 2024?
Here are my impressions from 3 interesting presentations related to head and neck cancer: S2-S3, Yom et al., Interim futility results of NRG-HN005 a randomized phase II/III non-inferiority trial for non-smoking p16+ oropharyngeal ca. The study tested non-inferiority regarding DFS of two de-escalate...
How would you approach de novo metastatic castrate sensitive prostate cancer with extensive locoregional spread causing rectal compression, retroperitoneal lymphadenopathy, and PSA >3000 but no visceral or bone metastases?
It sounds like from the question that the patient has T4 disease invading the rectum. This makes the patient ineligible for surgical resection with curative intent. He might still be a candidate for curative intent radiation therapy/ADT +/- abiraterone per STAMPEDE. His highly elevated PSA is very w...
Would you recommend surgery or stereotactic radiation therapy for a young woman with high-grade serous ovarian cancer presenting with a pelvic LN oligometastasis following maintenance therapy?
Like OM, the principle for other cancer favors SBRT as has excellent local control and low morbidity Donovan et al., PMID 38869888
How do you define the suprapubic volume for adjuvant penile cancer treatment?
A recent publication (Cooper et al., PMID 40180061) from the InPACT (NCT02305654) investigators, representing an international group consensus on both indications for RT and target volume delineation for penile cancer, may be helpful. This publication gives some guidance into the definition of this ...
How would you treat progressive Rosai Dorfman Destombes disease after initial limited radiation therapy?
To provide the best answer, we need a little more detail on this case. Also, is the patient symptomatic from the abdominal disease? If not, I would observe in the short term. If symptomatic, I would do PET/CT and consider a repeat biopsy, given the risk of the development of another process. Do you ...