Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach salvage of a local-only recrurrence of prostate cancer after definitive external beam radiation?
We continue to prefer "zero margin" whole gland "HDR-like" SBRT for this circumstance for prior external beam RT cases, *34 Gy/5 fx, though would exclude any patient that has preexisting grade 2 or higher toxicity from their original RT course (otherwise, no specific exclusions, if the metastatic w/...
How do you choose between ALND and RNI in the setting of LYMPHA or S-Lympha surgery?
The addition of microsurgical reconstruction with procedures such as LYMPHA, etc, has not necessarily changed the choice or clinical indications/scenarios for when ALND is done for a patient. However, I would say that if ALND is expected or planned for a patient, our breast surgical oncologists will...
What dose-fractionation and CTV margins do you typically employ for a CNS hemangiopericytoma?
I would discuss this at a multidisciplinary brain tumor board with my pathologists, neurosurgeons, neuro-oncologists, neuro-radiologists and would want to know the grade as well as extent of resection. Also, consider workup including spine imaging. In general, for grade 1 grossly resected hemangiope...
Do you consider chest wall constraints when treating with 5-fraction APBI?
We don’t have specific for chest as following APBI dose constraints keeps it within acceptable limits if chest wall is part of PTV.
How would you treat a pt with cT2N0M0 SCC of the supraglottic larynx (good PS, swallowing function) with a bulky primary tumor?
The University of Florida data suggests that bulky supraglottic larynx cancer >6 cc have relatively poor local control following standard fractionated RT. Altered fractionated RT, specifically hyperfractionated, may improve the results. The question is how to weigh hyperfractionated RT vs concurrent...
Do you treat early-stage dupuytrens disease with radiotherapy?
Yes. Below are excellent references with long-term results and descriptions of technique. 1. Betz, N., Ott, O.J., Adamietz, B. et al. Radiotherapy in Early-Stage Dupuytren's Contracture: Long-term results after 13 years. Strahlenther Onkol (2010) 186: 82-90.2. Seegenschmiedt M.H., Keilholz L., Wielp...
In light of the AMAROS trial, how do you decide between ALND vs. axillary RT?
These clinical scenarios will be faced more often by radiation oncologists.In the old French and NSABP B4 data, the regional control rates between surgery and radiation were very similar for clinically node negative patients, but these studies did not gain much traction because chemotherapy decision...
Has there been an observed interaction between ACE inhibitors and development of angioedema in a block demarcated superficial radiation therapy treatment volume (ex. lip)?
ACE inhibitors are the leading cause of drug-induced edema in the US (ACE inhibitor-induced angioedema - UpToDate). It was likely not related to the radiotherapy.
How do you justify adjuvant radiotherapy in pancreatic cancer?
Even though it was flawed in every imaginal way, ESPAC1 had a high impact and made post-op chemoradiation experimental. Prior to that, radiation was not based on very much evidence. GITSG was a 40-patient positive study; the EORTC trial was negative. After the ESPAC1, the focus shifted to neoadjuvan...
Would you offer pelvic re-irradiation in the setting of locally recurrent anal cancer in the presacral region?
Re-irradiation is always tricky. I don't want to miss a chance to help someone, and I really don't want to hurt someone. With re-irradiation, the devil is in the details. If it is small, in a spot where symptomatic toxicity is less likely, and a long period of time has passed since the original chem...