Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
In the wake of the COVID-19 pandemic, are there any hypofractionated regimens (without concurrent chemotherapy) that could be utilized for head /neck cancer in a post operative setting?
A very recent paper by Eric Hall and David Brenner’s group (Shuryak et al., Int J Radiation Oncol Biol Phys 2019) is titled “optimized hypofractionation can markedly improve tumor control and decrease late effects for head and neck cancer”. Using a recently improved model, they concluded that an opt...
Are any centers routinely using 55 Gy in 20 fractions with chemotherapy for definitive treatment of head and neck cancer following presentation of the HYPNO study?
I would not consider 55 Gy in 20 fractions a standard approach. The comparator arm was not standard practice in the US (66 Gy in 33 fractions with 5 weekly cycles of cisplatin at 35 mg/m2). Both the total RT dose (66 Gy < 70 Gy) and the total cisplatin dose (cumulative dose 175 mg/m2, less than the ...
What are your institution's standard liquid intake instructions for prostate cancer patients going through definitive external beam radiation?
Bladder filling is an endless source of stress for patients (and radiation therapists). It's hard for people to time bladder filling under ideal conditions, and even more challenging when the urethra and bladder are irritated from treatment. As the question alludes to, baseline hydration status infl...
When do you start a vaginal dilator after EBRT to the vaginal canal?
Although I have not reviewed the published data in a while, from my data review ~8 years ago and my own cumulative gynecologic specialty experience, I have fallen into the following paradigm: In the setting of standard EBRT or vaginal cuff brachy, for a patient, in reference to the use of a vaginal ...
How do you approach the treatment of de novo, brain-only metastatic HER2 positive breast cancer?
Patients who present with de novo, brain-only metastases of HER2+ breast cancer are rare, and hence, there is no good clinical experience or clinical trial basis upon which to base clinical practice recommendations. The current ASCO guidelines for the management of HER2+ brain metastases call for ap...
How would you boost a high-risk prostate cancer patient who received standard fractionation treatment and is not able to get LDR boost given COVID-19?
I will assume for the sake of argument that he is also getting ADT as part of his treatment. If he has responded well to ADT (I like to see about a 90% drop in the PSA within 3 months), my preference would be to try to delay until it's reasonable from an infectious disease perspective to proceed wit...
How will your management of head and neck cancers change with the COVID-19 pandemic?
Short answer: Most head and neck cancer radiation is as necessary as it gets. At this point, my management won't change very much. That may change as the pandemic evolves. Use all the appropriate precautions to stop the spread of COVID-19 and other viruses (we are using masks for every staff member,...
Would you offer radiation for suspected retroperitoneal nodal metastases in a patient with metastatic colorectal cancer with a single liver metastasis who had an excellent response to neoadjuvant chemotherapy?
Yes, in the setting of all other disease likely controlled and response to systemic, the control of the RP nodes (gross and microscopic) should be considered definitive and curative. RP/PA nodes should be considered N2 rather than M1. As such, elective nodal RT should also be given with IMRT, not SB...
What is the consensus on the size of the expansion from the gross tumor volume (CTV) to the clinical target volume (PTV) in treating intact supraglottic squamous cell carcinoma with radiotherapy?
The modern approach for head and neck cancer, based on international guidelines, has been CTV high dose (70 Gy) = GTV + 5 mm expansion (respecting anatomic boundaries and structures not at risk). Some centers in the past and present have also had an intermediate volume where an additional 5mm is add...