Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there an effective therapy for radiation myelitis?
While unproven for CNS or nervous symptom radiation toxicity, Pentoxifylline plus vitamin E may be beneficial. (Chahal et al., PMID 23132124). I have found it helpful for H&N patients with oropharyngeal soft-tissue necrosis and it is unlikely to be harmful.
How would you manage the primary site of a metastatic nasopharyngeal cancer showing cCR after systemic therapy?
Small phase III randomized trial of metastatic nasopharyngeal cancer patients with a CR/PR by imaging after 3 cycles of cisplatin/5FU showed that RT+chemo (primary/nodes + elective nodes) had an overall survival advantage compared with chemotherapy alone (You et al., PMID 32701129).
Are there clinical features that would lead you to consider combining SBRT + immunotherapy in a high risk early stage NSCLC?
I currently only use SBRT + immunotherapy in medically inoperable, early-stage NSCLC on clinical trial, as it is not yet a standard of care for early-stage disease. There are several randomized phase 3 trials currently testing immunotherapy in this patient population, however. On SWOG/NRG S1914, a p...
How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?
Unfortunately, this patient has a very poor prognosis. Due to the nature of her tumor being poorly differentiated, her disease is more likely than not to be refractory to radioiodine. If her disease in the thyroid and neck has not been addressed, external beam radiation therapy should be offered for...
Can a nonbulky, T1-2 supraglottic larynx cancer near the vocal cords be treated like a glottic tumor?
The supraglottic larynx and the pharynx, unlike the glottic larynx, share similar embryological origins and therefore exhibit analogous lymphatic drainage patterns to levels II and III. Therefore, occult dissemination to regional lymph nodes has to be considered regardless of the characteristics of ...
What are your dose constraints for SBRT pancreas (absolute and relative) when treating with 5 fractions?
We contour duodenum, other small bowel, and stomach separately and for each allow V33 < 1cc and max 0.035 cc < 36-38 Gy. We will sometimes also add a 3mm PRV for these organs (if close) and try to keep this v35 < 1-2 cc. Of note, some protocols allow for higher dose to these structures...but on prot...
Do you use nomograms to decide whether to treat pelvic nodes in high-intermediate to high risk prostate cancer?
Rather than using risk estimate, my practice is to treat nodes for all high risk patients unless there is a contraindication. The nodal group I treat is distal common iliac, external, internal iliac, obturator and presacral region. The contouring principal is same for all pelvic malignancies and is ...
For a patient with stage IIB pure seminoma s/p orchiectomy who has bilateral RP adenopathy, do you also cover the contralateral iliac nodes in the dog-leg field?
I would treat ipsilateral pelvic node only Wilder et al., PMID 22436787
What is the role of GammaTile in the management of primary brain tumors and brain metastases?
GammaTiles are an intracranial brachytherapy product marketed by GT Medical Technologies consisting of a Cs-131 source imbedded within a collagen matrix. Proponents of the technology argue that advantages of GammaTiles over external beam radiotherapy techniques include the ability to “start” the rad...
Is it acceptable to use once daily fractionation for small cell lung cancer?
This question is still very relevant of further discussion. This particular poll and commentary began in June 2016! For the record, as of today I still prefer 45 Gy in 30 fractions delivered BID. For those that cannot come to treatment twice-daily, I use 60-66 Gy in 30-33 fractions based on OAR cons...