Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your preferred regimen for palliative treatment of unresectable retroperitoneal sarcoma?
First, I’d distinguish: 1) If the goals are PURELY palliative, can pick a conventional (30/10) or more adventurous (39/13, QuadShot, etc) palliative regimen - there is a separate MedNet thread on dose/fractionation for sarcoma palliation. But efficacy and durability are likely limited. 2) If the pri...
How often do you utilize intrafraction motion tracking when treating prostate cancer?
Why not?
Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?
This is an important question with implications for both overall survival (OS) and quality of life (QOL) where level-1 evidence is currently lacking. It is also the subject of an ongoing phase 3 trial (SWOG S1827/Maverick) that randomizes patients with limited-stage (LS) and extensive-stage (ES) SCL...
In a patient with T2N0 breast cancer with skin involvement s/p lumpectomy and negative margins, if you are offering whole breast radiation, would you bolus your tangent fields?
I tend to use small bolus over the scar area in this setting
What dose do you typically prescribe to the primary tumor for definitive treatment of squamous cell carcinoma of the anal canal (given concurrently with chemotherapy)?
With IMRT: Primary TX and T1: 50 Gy/ 25 fx SIB to primary and 42 Gy microscopic T2: 54Gy /27 SIB and 45 Gy microscopic T3 58Gy /29 SIB and 47Gy microscopic T4 58Gy /29 SIB and 47Gy microscopic Nodes (all with no CTV/5mm PTV within the microscopic dose above): <2cm 50Gy SIB 2-5 cm 54Gy* SIB >5cm 5...
Would you recommend adjuvant radiation to the breast for low grade adenosquamous carcinoma after lumpectomy?
There is scarce data on these rare histologies. With lumpectomy given the uncertainties, I would offer radiation. This is likely triple negative as well. The latest guidelines on whole breast fractionation from ASTRO suggest that in these rare histologies that usually arise in other parts of the bod...
What are the realistic, modern 10-year survival curves for localized prostate cancer given the improvements we have made in diagnostics and treatment?
Generally, outcomes are excellent for the average patient with localized prostate cancer. As all-cause mortality is driven by competing risks for patients with localized prostate cancer, the age and overall health of a patient are often the most important prognostic factors to predict overall surviv...
In which patients with early stage rectal cancer treated according to the PROSPECT paradigm do you recommend adjuvant chemotherapy?
Great question and great observation. The most recent NCCN guidelines (version 1.2024-page REC-6) clearly listed neoadjuvant chemotherapy without radiation as an option for patients with no T4 disease eligible for sphincter-sparing surgery. After the neoadjuvant chemotherapy, if tumor regression is ...
Should I treat a patient who doesn't know she has cancer?
Interesting opinions. Wonder if anyone has their own experience. I will bite. My grandfather was diagnosed with mesothelioma (he had worked in a salt plant laden with asbestos). He had 9 children in North America and was staying with them. They chose, as a family, not to tell him he had cancer. We a...
Would you feel comfortable doing high tangents with ultra-hypofractionation?
I would have no problem. 26/5 to CW + regional nodes has been studied and they do fine - and that's a much larger volume. Can discuss pros and cons and pre-emptively discuss lymphedema management, but it appears to be reasonable.That being said, it's only 10 more treatments for a course that we know...