Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach ITCs in sentinel lymph node biopsy in a vulvar cancer patient?
If only SNLN bx is done, then based on GROINNS data, there is a 5% risk of additional node. Since nodal recurrences have a low salvage rate, I would treat with adjuvant RT.
How would you deliver whole breast radiotherapy in someone who cannot raise their ipsilateral arm above their head due to recent shoulder replacement surgery?
Sometimes this comes up. If related to axillary surgery, I will often send to physical therapy/breast therapy and delay simulation for a few weeks. However, there are some cases where there is a preexisting shoulder issue. In these cases, I try to have arm akimbo and will consider VMAT whole breast ...
How do you manage focal DCIS in mammoplasty specimen?
There is uncertainty in these pts as volume of disease and margin status is not known. but if it is focal and low to intermediate grade then observation with antiestrogen is also reasonable If treat would offer hypofractionation course .
How do you approach treatment of a recurrent low grade glioma several years removed from prior radiotherapy?
It's hard to tell based on the question, but assuming the patient still has a LGG on recurrence and a high grade transformation hasn't taken place, it can be reasonable to re treat to full dose 45-54 Gy (assuming can meet dose constraints to normal structures). Factors to take into account are IDH m...
Have you seen an increase in rectal spasms with short course vs long course radiation for rectal cancer?
The side effect profile is very different with 25/5 RT vs long course CRT. There is no question that 25/5 is “easier” to finish, because the side effects almost invariably start after the last fraction. The acute toxicity of 25/5 is after treatment and, as mentioned above, includes spasm, sensation ...
Would you recommend ADT in a patient receiving salvage post-prostatectomy radiation with PSA <0.5 and a high Decipher score?
Certainly, this is an area of evolving management. Here’s what we know about the use of ADT in the salvage setting: RTOG 9601: 2 years of bicalutamide improved 12y OS but PSA at the time of salvage was a significant interaction term with PSA <0.7 receiving no benefit. 2 years of bicalutamide was ass...
What dose and regimen would you treat a stage I laryngeal cancer s/p R1 resection?
63 Gy at 2.25 Gy per fraction larynx only fields
How do you counsel NCCN low and very low risk prostate cancer patients who receive a high risk DECIPHER score?
I do not order Decipher in NCCN low or very low risk. I'm not sure very low risk is even a relevant category in modern practice. The 15-year results from ProtecT demonstrate excellent outcomes for those on the active monitoring arm. Critically, those patients were mostly diagnosed in the pre-MRI era...
Does Neurosurgery need to be consulted for assessment of spinal stability in patients with cervical spine mets prior to starting RT?
To address the first question, for me personally, I would feel uncomfortable not including neurosurgery. Fortunately, there has been good work in this area by the Spinal Oncology Study group to help clinically clarify the matter. That is, these folks in 2010, developed a so-called "Spinal Instabilit...
Do you recommend sentinel node biopsy or ALND in cT4 or cT3 cN0 breast cancer patients?
The major trials comparing SLNB versus ALND (i.e., Table 1 from Lyman et al. 2014) either required tumors to be small (<= 2-3 cm), or had few patients with larger tumors (e.g., NSABP B-32: less than 2% with tumor > 4 cm; ALMANAC: 2% with tumor > 5 cm). Similarly, the major surgical trials comparing ...