Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage early stage breast cancer patients with suspicious internal mammary nodes on imaging?
In patients with a suspicious IMN, who are getting BCT, I would: a. Include the IMN chain in the target volume and give it the same dose as the breast is getting. b. Boost the IMN suspicious area to a dose that would reasonably sterilize that node. In the era of 2 Gy per fraction, that typically wou...
What dose constraints would you use if reirradiating the prostate using SBRT?
This is a difficult question to answer in this forum due to the limited availability of prospective data on which to define optimal OAR tolerance. The answer would depend on the dose, fractionation, treatment volume (GTV vs. whole gland), and technique which would be employed (CK vs. IMRT/VMAT). The...
Do you use the re-radiation schedule 39Gy in 26 fx BID for a rectal patient who initially received 25 Gy in 5 fractions and then has pelvic recurrence?
We have retreated rectal cancer patients with pelvic reRT (using protons) with doses as high as 39-45 Gy BID after both conventional fractionation and 25 Gy/5fx. In patients with prolonged interval since the original RT, no other sites of disease, good ECOG, and no good systemic/surgical options, th...
What evidence is there for the benefit of adjuvant radiation therapy for a large primary thoracic synovial sarcoma that was completely resected?
Yes. Exstrapolating from extremity data for high grade sarcomas with marginal or wide margins postop RT improves cure in absence of radical margins.
What radiation dose is appropriate for unresectable spindle cell sarcoma of the spine?
First, it is important to note that radiation associated sarcomas are not necessarily more radiation resistant as very early experiments by Herman Suit demonstrated, and more recent series suggest that when necessary local control of RAS benefits from radiation therapy. The dose of radiation would ...
Is chemoradiation the preferred treatment for T2 SCC of the anal canal in a patient with IBD?
Yes, but I typically reduce the dose. In this case, 50.4 Gy in 28 fractions with 2 agent chemotherapy is a very good treatment. The worst case scenario is that the patient would need an APR. That could be because you declined to treat her or him, or because the tumor was not controlled with 50.4Gy. ...
Is adenocarcinoma of the vulva more radioresistant than squamous cell carcinoma?
In general, SCC responds better to radiotherapy than adenocarcinoma, therefore I agree with @Dr. First Last that I would advocate for surgery (if possible) for these entities - however, given their location (close to introitus), often they will warrant adjuvant radiotherapy.
In patients with high risk prostate cancer and involved common iliac lymph nodes would you recommend radiation?
This study from Tata, Mumbai shows outcome data treating pelvis only up to the common iliac nodal region and shows similar outcomes for pelvic node, proximal and distal common iliac positive disease Chopade et al., PMID 35870708
Under what circumstances would you offer PMRT in a patient with DCIS?
I favor in the setting of multiple positive margins, especially for high-grade DCIS.
How would you approach a mediastinal-only presentation of squamous cell carcinoma of the lung s/p lymph node biopsy consistent with lung origin, with PET positive for only mediastinal disease?
First, I would confirm no prior cancer diagnosis, review in detail with a multidisciplinary tumor board, and try to rule out the non-lung primary site. If no primary can be found, and PET demonstrates limited disease only in the mediastinum/hilum, then I would just treat the disease that you can see...