Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a standard spinal SBRT dose regimen for patients with "oligometastatic" disease being treated with curative intent?
The simple answer is NO - there is no standard spinal SBRT dose regimen for patients with oligometastatic disease. There are a number of publications that demonstrate very good tumor control using 18-24 Gy in a single fraction, as well as a variety of hypofractionated treatment schedules in a variet...
Would you ever omit or reduce prostate bed radiation in a post-prostatectomy patient who develops recurrence in pelvic LNs?
In STORM, which is a phase 2 study looking at elective nodal RT vs SBRT for nodal recurrence presented at ESTRO, local recurrence was 5% in the group that got prostate bed plus nodal RT vs. 14% in the group that received only SBRT to node suggesting benefit of treating prostate bed for nodal relapse...
Do you consider regional nodal irradiation for women with ER+ breast cancer with a single micrometastasis after lumpectomy and sentinel lymph node sampling?
The data suggest excellent regional control with any approach like no additional treatment (Z11 and IBCSG) or regional nodal RT (AMAROS). Our approach for majority of patients with micromets is to cover level 1 and 2 node in tangential beam ( unless tripe negative then may consider RNI)
Would you consider a patient with DLBCL to have CNS involvement if no brain lesion is seen on imaging, CSF flow cytometry is negative, but PCR is positive for MYD88 and KMT2D mutations?
Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma contained within the ventricles of the brain and the subarachnoid spaces of the cranium and spine. It is possible that cfDNA fragments containing MYD88 and KMT2D mutations may have found their way into the CSF and thereby detected by PCR techni...
Should we be performing sentinel lymph node biopsies for HR+ patients ≥70 years of age?
I do not think that the monarchE data for adjuvant abemaciclib warrants changing our standard practice around omission of SLNB for patients >/= 70 yo with low-risk HR+/HER2- tumors that are clinically node-negative, because adjuvant abemaciclib is largely only appropriate for higher risk tumors and ...
What dose and fractionation would you deliver to the sole of the foot in a patient with multifocal cutaneous DLBCL that is resistant to systemic therapy?
We need some more information here. Does multifocal mean the patient has multiple skin lesions? The diagnosis of cutaneous DLBCL is also somewhat ambiguous. Is this cutaneous DLBCL leg type, a specific entity in the WHO pathology classification, or perhaps the older WHO classification is being used ...
What do you consider to be the minimum technological requirements to safely deliver spine SBRT?
In the spirit of careful attention to detail, there are a number of ways to answer this question. I will draw from our early institutional experience to prove some guidance on minimal technologic requirements for safe spine SBRT. The key elements are 1. Accurate imaging for target and organs at risk...
What marginal SRS dose do you prescribe for brain metastases 2 cm or smaller?
Many gamma knife centers have gotten away from the 24 Gy marginal dose based on rates of treatment related imaging changes/radiation necrosis. At Yale, we use 22 Gy as our "top" dose. We have an ongoing prospective phase I/II trial investigating dose selection for gamma knife based on a grid of dose...
Do you recommend concurrent cisplatin and gemcitabine with radiotherapy for unresectable vulvar cancer, as described in GOG-279?
We are still doing weekly cisplatinum with a higher dose of RT as there is concern about additional morbidity with the addition of gemzar. Richman et al., PMID 32981696
Is a close but negative for margin (<5 mm) an indication for adjuvant radiation in oral cavity squamous cell carcinoma?
I treat a close margin in the high-risk post-op PTV (66Gy) but I do not ask med onc to add chemotherapy unless the margin is a true positive.