Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you omit RT for pleomorphic LCIS?
PLCIS in limited data appears to behave like high grade DCIS with progression to invasive disease like DCIS. It is presumed based on data that in older DCIS studies they were included as they present like DCIS with microcalcs and morphologically can be confused with DCIS (as IHC like E cad stains we...
Is there a role for radiation therapy for florid LCIS managed with lumpectomy?
There is no role for RT for classical or florid DCIS. If it meets the criteria for pleomorphic LCIS, then would treat like DCIS with RT.
How do you approach treatment of brainstem metastases in the setting of prior WBRT?
Depending on the proximity of the WBRT the answer differs. If WBRT is more than 6 months prior I do not alter my prescription.For more immediate WBRT - say as a post WBRT boost I keep the dose low to a conformal plan. 8-10 Gy single session and 15-18 in three fractions.For our brainstem mets results...
What is the role of liver SBRT in the setting of an excellent interventional radiology program?
An excellent question, there is certainly a significant role for a liver SBRT program in the setting of an excellent and talented interventional radiology group. The important hurdle that must be overcome for this to take hold is for everyone to view this as a collaboration rather than a competition...
What radiation dose and fractionation schedule do you use to treat atypical carcinoid tumors in patients who are medically inoperable?
I would treat an atypical carcinoid with whatever dose I would normally use for a Non-Small Cell Lung cancer. Choice is driven by size and location, not by histology. Frankly at this point, we could lump Small Cell Lung cancer in there as well... There is little reason to choose radiation dose like ...
In which prostate cancer patients, if any, do you consider adding ADT to adjuvant radiation therapy following prostatectomy?
Two trials (RTOG 9601 and GETUG-AFU 16) have demonstrated a benefit to adding ADT to salvage radiotherapy, and both required a minimum PSA of 0.2 ng/ml or higher. In RTOG 9601, the subgroup of patients who appeared to benefit most from ADT were those with PSA >0.7 ng/ml, suggesting that concurrent A...
If a patient has a mediport within the radiation field, will you insist the patient have it removed prior to radiation?
I do not move ports from the chest wall normally out of the way during usual photon radiation fields even if they are on the same side as a breast or chest wall I am treating. I have treated them in a tangent or a supraclavicular photon field without any apparent problems. But it could cause a theor...
Would you re-irradiate the axilla after a resection for an isolated axilla recurrence in a breast cancer patient who had prior radiation to the breast and axilla?
I have, in the past, treated resected axilla recurrence with matted nodes/ECE where local recurrence risk was high and there was only partial overlap with the prior fields treated a few years prior. In those cases, I will include previously non-radiated nodal areas but not the breast/chest wall if i...
What volume would you treat for an isolated axillary recurrence after BCS and whole breast RT who have resection of the recurrent disease?
In the case of prior whole breast (or chest wall only) radiation, I would typically only treat the nodal region after a isolated regional recurrence. The target volume should include at least the undissected axilla and infra/supraclavicular stations. I have not treated the IMNs after an isolated axi...
Is there a firm rib dose constraint when treating lung tumors abutting the visceral pleura/chest wall with SBRT?
While I am concerned about chestwall pain and rib fractures, I am usually reluctant to alter my volume or dose. At the Radium Society Meeting in 2013, Ben Slotman released data on local recurrences after SBRT, and he found a 3 year recurrence rate of ~8%. More interestingly, he found that 56% of the...