Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you ever offer definitive XRT in a patient with an elevated PSA (assume over 30) but who refuses prostate biopsy?
Absolutely not! There are too many benign processes that can cause an elevated PSA. Furthermore, patient-specific treatment options would differ based upon pathology. Gleason scoring is a primary driver for categorizing AJCC and other risk classification schemes. Genomic classification also requires...
To what dose do you treat the seminal vesicles in intermediate and high risk prostate cancer?
For men with unfavorable intermediate or high risk prostate cancer and T1c-2 disease, treatment of the SV's is recommended (following what you would do for local control if you had a RP - i.e. complete removal of the SV's) to a total dose of at least 70.2 Gy but rectum permitting (i.e. Rectal V70 < ...
Can you omit the vulva from the radiation field in isolated LN recurrence several years after initial vulvectomy/nodal dissection without adjuvant RT?
In my opinion, yes, assuming the patient has had a recent well-done pelvic examination with close inspection of the vulva and vagina. A more difficult question, I think, is whether to treat the ipsilateral pelvic LN's. In general I would favor treating ipsilateral pelvic LN's to microscopic disease ...
For primary angiosarcoma of the breast following mastectomy, what would your targets be for adjuvant radiation therapy?
For primary angiosarcomas, I typically treat chest wall only as long as no clinically involved nodes. Will go to 60 Gy postop with bolus if margin is negative.
Is it reasonable to extrapolate data from Glioblastoma and discuss Tumor Treating Fields in patients with Grade 4, IDH Mutant, astrocytomas?
While more than 90% of Grade 4 gliomas are IDH wildtype tumors (GBMs), this question does come up occasionally. Since I have no personal experience with TTF, I asked my collaborator Chirag Patel, MD, a neuro-oncologist at MDACC who regularly uses TTF in his patients, to provide his opinion. So pleas...
How do you approach isolated CNS recurrence in previously treated neuroblastoma?
As with other pediatric cancers, the CNS can be a sanctuary site for relapse given the poor CNS penetration of many conventional therapeutics used in the front line setting. As such, there has been an increasing frequency of CNS failures which can occur as early as a year to as late as 5-10 years in...
In small intracanalicular acoustic neuromas with facial nerve dysfunction, is there benefit for hypofractionation (5 Gy by 5 fractions) as opposed to single fraction SRS?
Unusual for a “small” acoustic to cause a cranial nerve deficit. I’d use conventional 50.4 Gy at 1.8 Gy per fraction.
How do you manage colorectal tumors that have components in the colon and rectum on MRI?
For a tumor straddling the peritoneal reflection, it is only the rectal component that would make one consider RT. The reason for a local recurrence of rectal cancer is residual disease from the primary tumor either at the margin of resection of the primary tumor or from residual lymph nodes in the ...
Would you recommend PMRT for multifocal IDC with extensive LVI and 1 SLN with ITCs?
I would not typically offer PMRT in this situation if pT1-2 with negative margins; I will counsel on the risk of recurrence and the impact of LVSI. With pT3 disease, I will discuss the data available and the pros/cons of PMRT.
How would you treat a solitary intracranial oligometastasis from Ewing's sarcoma that has been resected?
While an uncommon occurrence in pediatric sarcomas, as much as 2-3% of pediatric RMS and EWS cases can metastasize to the CNS. The optimal management strategy has not been evaluated systematically in prior trials due to the rarity of the event. It’s worth noting that many patients with oligometast...