Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What tissue tolerance constraints do you use for the esophagus, spinal cord, and heart for reirradiation of a NSCLC mediastinal lymph node failure?
I opted to write a response to this question, but honestly the answer is elusive to me. With respect to SBRT: for spinal cord, I rely on Dr. Sahgal’s work (he has several papers on this topic); for other organs, there are less data.For conventionally fractionated radiation, most are familiar with th...
Would you go back and do an axillary lymph node dissection if a sentinel lymph node biopsy showed a single lymph node with extracapsular extension?
For microscopic ECE, would manage with comprehensive RNI but if gross ECE, would favor dissection and then RT.
Would you recommend axillary dissection for a patient with cT1N1 triple negative metaplastic breast cancer?
Although these cancers are underrepresented in SNLN and RT studies, we treat with the same principle like any other breast cancer with SNLN bx. Gebhardt et al., PMID 30197938
Would you recommend decreasing dose to the whole breast and nodes if constraints cannot be met?
For breast would not decrease dose but would block area of breast if feel risk of microscopic disease low to achieve normal tissue dosimetry For prophylactic treatment of IM node have decreased dose to 40 gy for coverage or even excluded them if lung and heart dose a concern
Do your radiation treatment margins change for cutaneous basal cell carcinoma in the adjuvant setting compared to cutaneous squamous cell carcinoma?
1 cm with orthovoltage, 2 cm with electrons collimated on the skin.
Would you consider splenic radiation in stage IV CD5+ DLBCL involving the bone marrow in patients who initially presented with symptomatic splenomegaly, anemia, and thrombocytopenia but achieved complete response on PET after 6 cycles of R-miniCHOP?
CD5 positivity is an adverse prognostic factor in DLBCL. About 5% of patients with DLBCL are CD5+. Other adverse risk factors are often present in these patients (advanced age, non-germinal center histology, high IPI, etc.). More generally speaking, the role of consolidation RT in advanced DLBCL is ...
For postoperative radiation for oral cavity cancer, should the entire surgical bed including grafts and plates (eg reconstructed mandible) receive the full 60 Gy?
Yes
Is there data to suggest that definitive chemoradiation to 70Gy vs. postoperative chemoradiation to 60 or 66Gy has any different clinically significant effects on long term swallowing function and other side effects of H&N cancer treatment?
There are no good comparisons. The surgical literature that focuses on TLM/TORS tries to make this claim, but if you look at modern IMRT series, G-tube rates are equivalent, and are in part dependent on T_stage, since a T4 pt is more likely than a T1 pt to get chronic dysphagia. There are also no co...
For early stage indolent NHL (low grade follicular, MALT) involving midline structures of the head and neck (ie base of tongue, soft palate) how do you apply the concepts of ISRT?
@Dr. First Last,I think your question is a good one and probably not one answerable by definitive data. However, the recent publication of the ILROG guidelines on extranodal disease (Yahalom et al, https://www.ncbi.nlm.nih.gov/pubmed/25863750) and bulk of available data I believe suggest that it’s o...
In what situations would a standard FDG PET/CT be useful in the evaluation of high risk prostate cancer?
Overall, my impression is that the use of FDG PET for this purpose is limited. If interested, below is my rationale as summarized in the Conclusion.As mentioned, PSMA PET/CT is considered by many to be the current best standard of care for the staging evaluation of high-risk prostate cancer, and it ...