Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose and fractionation would you use for Kaposi’s sarcoma of the tonsil post op?
36 Gy/2 Gy X 18 to the surgical bed with IGRT and 40 Gy/20 to the positive margin area based on pre-op images with 10 mm margin for CTV expansion and 3-5 mm with CTV-PTV expansion. Quéro et al., PMID 35454820 Cihan, PMID 29383006
What dose are you routinely using for adjuvant RT for intermediate risk p16+ SCC of the OPX s/p TORS?
It's still just a phase II trial. Even the authors state in the introduction that their primary objectives were to demonstrate the feasibility of a prospective multi-institutional study of TOS for HPV+ OPC followed by risk-adjusted adjuvant therapy and that a planned phase III trial is in developmen...
Would you offer definitive radiation therapy for extracranial schwannoma located in the neck?
Yes. 50.4 Gy/28 fractions
When treating resected brain metastases with post-op SRS, what dose, fractionation and PTV margin do you use for large (>3 cm) cavities?
I would refer you to Scott Soltys' work:Choi et al., PMID 22652105Soltys et al., PMID 17881139This is also useful:Brennan et al., PMID 24331659
What RT dose (with chemo) would you use for small cell of the bladder?
Even in lung small cell cancer, we don't have consensus regarding the appropriate dose (see NCCN SCLC Principles of Radiation Therapy, for example). And of course, bladder small cell cancer is relatively uncommon so there's less data available.Thus my approach has been to use RT doses that are consi...
How would you approach patients with high risk mucoepidermoid carcinoma (high grade) of the parotid gland for optimal adjuvant treatment?
Would be nice to know all the risk factors - margins, PNI, etc.Due to high-risk features, adjuvant RT is appropriate and guideline-concordantHowever, there is no strong supporting evidence to add adjuvant chemo as salivary gland cancers are typically not chemo-sensitive.Published real-world data suc...
For brain metastases, what is the optimal time interval between surgery and post-operative SRS?
There is no clear consensus on the optimal time interval between surgery and post-operative SRS. In practice, several factors would play a role in the timing of post-operative SRS. Notably, I would say rather than post-operative SRS, I would argue whether my intent is adjuvant SRS or salvage SRS, me...
Do you recommend homogenous or inhomogenous dose distribution for postoperative SRS/FSRT for a resected brain metastasis?
For most intracranial and all malignant targets, homogeneous planning leads to poorer dosimetry and bad radiosurgery. Just don't do it. If you value conformity and gradient as plan quality metrics, you should not penalize heterogeneity within your target. For inversely planned SRS, the act of merely...
Would you offer post-operative SRS/SBRT in the case of a resected brain metastasis from metastatic NSCLC with an EGFR mutation?
Absolutely. For symptomatic brain metastases, I would not rely on the efficacy of systemic therapy alone either in the intact or post-operative setting. CNS objective response rates are around 60% for osimertinib with DCR around 90% which is quite good. However, intracranial complete response rates ...
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
This is an excellent question.Our group has been involved with amyloid/radiation effects in patients with Alzheimer’s disease Turn our initial run-up and through our most recent reviews, I have not seen any significant publications nor have I seen clinical situations that this addresses, although am...