Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What radiation dose would you use for T4 prostate cancer?
Local therapy for T4 prostate cancer is critical. It needs to get the full dose to ensure good control. There is very little information about the specifics of the radiotherapy, and I don't believe there is any toxicity data specifically for cT4 lesions. However, there is data showing local therapy ...
What is your radiation approach/details for regionally involved prostate cancer (N1)?
For intact cases, I usually attempt to deliver a single-phase plan with multiple dose levels in 28 fractions as detailed below:Elective Pelvic LN volume (CTVn1): 50.4 Gy/28 fx. In cases of N1 disease, I would usually include the common iliacs. When the GTVn is near the cranial field edge, I usually ...
Is ultrahypofractionation appropriate for a B51 candidate receiving breast-only radiation?
"I believe in the data of biologic equivalence, and I just treated patient X with ultrahypofractionation (UHFRT)...but I can't treat patient Y (who looks extremely similar to patient X, with a few idiosyncrasies) with UHFRT...because '"reasons"' ...*scratches chin* Hard as it may be to believe, ther...
What "normal brain - PTV" dose constraint would you recommend for a large solitary cerebellar metastasis, planning 3 or 5 fraction SRT?
There are two relevant studies that I utilize for relevant planning considerations: HyTEC (which examined data from 51 reports for NCTP modeling for 1-, 3-, and 5-fractions) as well as Upadhyay et al. (which examined outcomes from a high-volume single-institution center where 3 fractions is their in...
Should methotrexate be stopped prior to radiation therapy if a patient has rheumatoid arthritis?
I have not stopped as dose of MTX for RA is low (7.5 mg) and there is data of CMF with RT for breast cancer with higher dose of MTX showing no significant increase in morbidity.
What volumes and dose would you use for a chest wall recurrence in a patient who had previous mastectomy and completed only a partial prior course of PMRT?
I would treat it like a new course, provided cumulative brachial plexus dose constraints are met.
In a patient with local recurrence of breast cancer after mastectomy, how would you sequence adjuvant treatment after wide local resection?
Endocrine therapy can be given simultaneously with RT without increasing toxicity or decreasing effectiveness, as shown in a randomized French-Swiss trial (Azria et al., PMID 20138810). Toxicities from chemotherapy may be greater and its effectiveness reduced (at least for high-risk patients) when g...
Would you recommend adjuvant radiation to the chest wall and/or regional lymphatics after a resected chest wall recurrence?
Absolutely, would treat chest wall and RNI including IMs in most cases
What dose constraints do you use for the pulmonary vein, pulmonary artery, and superior vena cava for thoracic reirradiation after prior conventional fractionation to a central lung tumor?
In my opinion, the best paper to address this is from Stanford University. The authors describe normal tissue toxicity after thoracic reirradiation. Various dose fractionation schedules were used for both the 1st and 2nd courses of radiation, with dose converted to conventional fractionation (2 Gy e...
What are your institutions' preferences on SBRT vs. histotripsy for treatment of liver metastases?
I'll avoid the institutional political discussion of competing modalities. Like many ablative modalities, there is limited data directly comparing the safety and effectiveness of SBRT. As the new kid on the block, histotripsy has no comparative data that I'm aware of with existing modalities.HistoSo...