Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel patients who will undergo external beam radiation regarding complications with breast implants from previous breast augmentation?
The best experience any individual can offer is likely anecdotal. There is one paper from the Mayo Clinic, which supports that most women are able to maintain an acceptable cosmetic outcome (about 2/3rd) and that with further intervention (i.e., capsulotomy) that number increased to 89%. The cosmesi...
Would you offer any degree of hypofractionation with concurrent chemotherapy for NSCLC?
I typically wouldn't, given limited data. CALGB 31102 (phase 1 trial) looked into this and found the maximal tolerated dose (MTD) to be at 60 Gy in 24 fractions (i.e., 2.5 Gy/fx). There's another phase 1 trial from Wisconsin which showed similar results (i.e., 2.5 Gy/fx). With these results in mind,...
What RT dose would you use to treat a single site relapse of high risk multiple myeloma?
Depending on the KPS of the patient, it may be 20 Gy in 5 to 36 Gy in 20. Data (Oertel et al., PMID 30987659) support upwards of over 45 Gy, but that is in the de-novo situation. This is post-treatment/transplant and represents a treatment failure and likely palliation. A 2005 paper on this subject ...
Do you deliver prostate SBRT every other day or consecutively?
Morgan S et al just published Hypofractionated radiation therapy for localized prostate cancer: Executive summary of an ASTRO, ASCO, and AUA Evidence-Based Guideline. It's an article in press in PRO right now. Question KQ4C addresses this question of daily fractionation and in the summary they writ...
When is SBRT or hypofractionated radiation appropriate as adjuvant treatment for pancreatic cancer?
There may be a variety of opinions about this question. 33 Gy in 5 looks to be as least as good as 50.4 Gy in 28 in unresectable pancreatic cancer and has had some improved pathologic responses in borderline resectable pancreatic cancer in experienced hands (Hermann et al., PMID 25538019). However, ...
Have the breast surgeons at your institution adopted the SOUND trial into their clinical practice?
Not at our institution with this practice still being limited to 70 and above.
When do you consider lymphadenectomy vs pelvic lymph node RT in a lymph node recurrence after prior prostatectomy or prostate-only RT?
I typically recommend a modified GETUG P07 (OLIGOPELVIS) treatment paradigm in this setting because I believe it has a favorable toxicity and short term treatment efficacy as well as the best evidence basis at this time. This regimen consists of a fractionated, extended pelvic nodal field with conco...
When would you opt to manage anal squamous cell carcinoma, HPV+ with surveillance vs adjuvant treatment following a trans-anal excision?
Never
How would you manage adjuvant therapy for a patient with pulmonary adenoid cystic carcinoma s/p resection with positive bronchial and vascular margins and nodal involvement?
Manage with adjuvant radiation. No role for systemic therapy concurrently or in adjuvant.
Do you recommend an additional procedure for melanomas if there is tumor within 1-2mm of the margin?
My understanding has been that a re-excision of melanoma is based on initial Breslow depth. As long as the margins are clear on that re-excision, regardless of being 1-2 mm away from any one edge, there is no indication for additional surgery.