Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever offer spine SBRT for patients with multiple adjacent involved vertebrae?
Yes, multiple spine segments can be treated. NRG 0631 included 2 contiguous spine levels for radiosurgery/SBRT. An earlier study (Ryu et al., PMID 17167762) showed that the spinal cord dose tends to be slightly higher when the length of the target volume is >6cm. This was the basis of including 2 co...
What dose would you use for multifocal, recurrent, subtotally resected pleomorphic adenoma of the left neck salivary glands?
I would take it to 60Gy
Do you ever treat patients with phyllodes tumor of the breast with adjuvant radiation?
The risk of local recurrence is small for patients with benign phyllodes tumors treated with lumpectomy or mastectomy, even if there are positive margins. Recurrences are almost always benign. Hence, there is no role for adjuvant RT for such patients. The available literature does not allow one to d...
When, if ever, would you trace the facial nerve back to the base of skull for a pleomorphic adenoma of the parotid?
I would not chase on a routine basis. If path read peri neural invasion and MRI were positive, I’d chase electively. But one should get path reviewed in these situations.
Are there any specific high risk features or situations for which you would offer adjuvant radiation to a newly diagnosed benign pleomorphic adenomas following resection?
In the non recurrent (upfront) setting, it is not popular to jump to post op RT. The main rationale for using RT in a relatively benign disease is if there is a high probability of recurrence based on certain characteristics such as intra operative spill, unresectable gross residual disease etc AND ...
When do you prefer to use bolus for treating superficial tumors adjacent to or involving the skin surface, especially for complex surface anatomy in the pelvis, head/neck, and extremity regions?
There is not a single answer to this question, as it depends on the specifics of the geometry, treatment technique (photons vs. electrons, beam angles, energy used, etc.), depth and size of the tumor, and other technical factors. Since almost no one has access to superficial or orthovoltage X-rays w...
What is the appropriate timing of CRT after TURBT for bladder preservation in the treatment of bladder cancer?
Our typical timeframe is 3-6 weeks. If it has been >8 weeks, we would recommend at least an office cystoscopy to confirm no gross residual/recurrent disease. We typically perform 2 TURBTs (one from referring and one at our institution) prior to CRT.
Would you offer partial breast irradiation to women who have HER2+ disease?
I agree with others that in the era of effective anti-HER2 systemic agents, the likelihood of in-breast recurrence can be very low for HER2 positive breast cancer patients undergoing breast conserving therapy. On the other hand, there is little to no prospective data regarding the efficacy of APBI. ...
How does your management of locally advanced NSCLC change in a patient with a previous contralateral pneumonectomy?
I've tried to tackle this a few times in my practice and it's uber hard. Depending on the size, it's often impossible. You are really stuck with the constraints for Mesothelioma in the setting of EPP. That is V20 of 7% and MLD of 8.5 Gy (Int. J. Radiation Oncology Biol. Phys., Vol. 69, No. 2, pp. 35...
In high risk prostate cancer treated with RT with neoadjuvant/concurrent ADT, is adjuvant intermittent ADT reasonable instead of continuous ADT?
As an option in general, I say no. Given multiple phase III trials showing an overall survival benefit of adjuvant ADT, I would need a robust non-inferiority study of intermittent ADT to recommend it. If a patient refuses or cannot tolerate continuous ADT but can tolerate intermittent, this is proba...