Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage unresectable esophageal cancer involving both the thoracic esophagus and GE junction?
We need to remember that RTOG-8501 treated the entire esophagus for the initial fields, so treating a large field is not unheard of. With modern day treatment planning and delivery, it would be reasonable to treat definitely to treat the entire CTV (defined as the esophagus and nodes) to 45 Gy and t...
Which genomic test do you choose for a patient with favorable intermediate prostate cancer trying to decide between active surveillance and treatment?
Decipher.
How would you approach radiotherapy planning for a pediatric patient with Ewing sarcoma of the spine (vertebral body primary)?
Per the recent AEWS 1031 protocol: GTV1 is defined as the visible and/or palpable disease defined by physical examination, CT, MRI, and/or PET prior to any surgical debulking or chemotherapy. GTV2 is defined as a residual visible or palpable tumor as assessed by CT, MRI, PET, or physical exam after ...
When treating rectal cancer with conventional neoadjuvant chemoradiation (45 Gy to pelvis with boost to 50.4 Gy), what volume do you use for the boost?
Great question. There does seem to be some variation in boost volume, particularly between 3D and IMRT treatments. At MDACC, we typically use a prone 3 field belly board technique for most rectal cancer patients receiving standard neoadjuvant long-course chemoradiation. The pelvis goes to 45Gy in 2...
How do you manage a bladder cancer patient who had a partial cystectomy with a positive margin?
In fewer than 5% of bladder cancer patients, partial cystectomy along with neoadjuvant cisplatin-based chemotherapy can be considered for stage II (cT2, N0) disease with a single tumor in a suitable location and no presence of carcinoma in situ, where an adequate margin of soft tissue and an adequat...
How would you plan sequencing of an MRI-directed prostate nodule micro-boost when doing a sequential plan?
Some reports do profile the use of a sequential tumor boost (e.g., Miralbell et al., PMID 19910135); however, I would usually not recommend this unless a brachytherapy boost is planned. Although I could think of a few niche circumstances where there could be a rationale for a sequential boost (SEQ),...
In a patient with cardiac comorbidities, who meets ASTRO APBI criteria other than a positive margin, would you offer APBI in an attempt to reduce cardiac dose?
There are still substantial uncertainties about the impact of specific risk factors on the local recurrence rate following PBI. A tumor-free margin width of less than 2 mm was associated with a high risk of local failure in a number of studies (Chen et al., PMID 16421922; Vicini et al., PMID 1730693...
How would you manage dysphagia and odynophagia in an otherwise healthy patient with newly diagnosed metastatic esophageal cancer with a large primary in the mid to distal esophagus?
Depending on patient goals of care, in an otherwise healthy patient starting with chemo to address both the esophageal cancer causing dysphagia as well as the systemic disease is also our preferred plan as well, with analgesics as needed for the odynophagia. Along with dietary modifications perhaps ...
When using conventionally fractionated breast RT, does one need to treat the whole breast to 50Gy or is 45Gy, followed by a boost satisfactory?
One of the reasons why hypofractionation schedule appears to have less acute and late morbidity in comparison to 50 Gy is because of lower equivalent total dose ( about 46 Gy equivalence). Besides the data is mostly on central axis dose homogeneity rather than 3D dose homogeneity and for that reason...
Would you treat the whole bladder with a cervical cancer that is invading the bladder?
The short answer is no. The posterior wall of the bladder is generally what will be involved and will be in the PTV anyway. This is how I would approach planning: I would fuse the MR T2 sequence with my planning CT, and use the cystoscopy report as well to ensure that the involved portion of the bl...