Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What SBRT dose and tissue constraints would you choose for a presacral rectal recurrence status post preoperative chemoradiation to 50.4 Gy followed by surgical resection in a patient who is not a candidate for surgical re-resection?
By first principes, irradiation should be given with lower doses per fraction, unless the recurrence is not near a critical structure such as bowel, ureter, periferal nerve or lumbosacrail plexus. Theses recurences are also multifical with nests of microscopic cells typically found in the surgical s...
How does RTOG 0815 change your recommendation for ST-ADT for men getting XRT for favorable intermediate risk prostate ca?
It is again a function of absolute risk and absolute and not relative benefit with ADT. Biomarker like decipher and artera helps quantify the absolute risk in this situation and guide in decision-making.
What volumes and prescription doses do you use when treating patients with unresectable cholangiocarcinoma?
Extrahepatic (EHC) and intrahepatic (IHC) cholangiocarcinoma are very different diseases. EHC tends to remain locoregional more often than IHC. Curative therapy must include surgery in general, but radiation has an important role, especially in patients with R+ resections. The data are not clear for...
Do you use any drugs prophylactically to reduce the risk of radiation pneumonitis in lung SBRT?
I have not although there are varying levels of evidence to support each of these agents. I think it points to a broader failure as a field to develop radioprotective strategies that could enhance our therapeutic ratio. RTOG 0123 made an attempt at a prospective evaluation of captopril to reduce rad...
Does the presence of multiple positive intramammary lymph nodes in the setting of negative sentinel lymph nodes cause you to treat regional lymphatics?
In the non-sentinel node era, all these patients had axillary dissection and had higher likelihood of the axilla being positive. In the era of sentinel node biopsy, we usually we don't change if sentinel node was mapped and sampled successfully. The thought process is for these patients is that the ...
What dose-fractionation regimen do you prefer when treating with hypofractionated whole breast radiation therapy without a boost for early stage breast cancer?
I typically use the Canadian fractionation, and boost patients who are young (<50), high grade, triple negative, or Her2+.
What is the appropriate radiation dose/volume for perianal basal cell carcinoma?
I would favor surgical management first of all for an anal margin cancer. If there is anal canal involvement and negative margins (>1 mm) can't be obtained without progressing to an APR, then I would consider treating with radiation to doses similar to anal squamous cell carcinoma. I would have a di...
For prostate cancer patients with N+ disease, is there evidence demonstrating improved outcomes with the addition of nodal RT, as opposed to prostate RT alone plus ADT?
There is no direct evidence. In the STAMPEDE trial, which showed benefit of RT in node positive patients, RT involved prostate and nodes in a majority of patients (>80%).
How do you treat unresectable pancreatic adenocarcinoma invading into the duodenum?
No, 54Gy did not improve survival in the LAP-07 trial, so it is definitively not a definitive dose. I would give 75Gy in 25 fx (100Gy BED) with capectabine. We have published how we do this in multiple papers, but essentially a 5mm duodenal PRV is carved out of the PTV75 so that there is a gradient...
How would you prescribe RT dose to post-op vulvar cancer with margins positive for severe dysplasia?
Need to quantify: If this positive dysplasia is dVIN, then I would favor re-excision, as it is high risk factor for local relapse and I don’t know if RT alone would be effective.