Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you balance target coverage vs cord constraints with spine SRS?
In general, balancing competing target coverage and OAR exposure considerations is always a risk/benefit proposition. Having a marginal failure where you sacrificed coverage to meet a constraint associated with a <5% complication rate is always cause for regret. If a cord constraint cannot be met wi...
How do you work-up and manage a patient with prostate cancer and a borderline enlarged pelvic lymph node?
My approach in this case is to start patients on ADT(and abiraterone if possible) and monitor for LN response with a 3mo CT scan. If LN shrinks, I consider them to be N+ and treat the pelvis, boost the LN if it is still of adequate size to do so (typically >5mm), and continue ADT for 2 years before ...
How do you treat encapsulated papillary carcinoma of the breast after lumpectomy with negative margins?
Encapsulated papillary carcinoma behave like DCIS and we use the same principles as we would use for managing DCIS.
When consolidating de novo oligometastatic NSCLC with initial hilar nodal involvement, would you still include the hilum if that disease completely responded to induction chemotherapy?
If the patient had oligo-met before induction chemotherapy, I would consider to TX all previously involved sites. However, if the patient has oligo-met after induction chemotherapy but had poly-met before chemotherapy, I would only TX active residual disease.
For ultracentral lung cancer abutting the heart, what dose constraints would you use for the heart and bronchus if using 10 fraction ultrahypofractionation?
The dose deviation from Timmerman for the heart is 60 Gy in 10 fractions. Now that they are published, I'd utilize the SUNSET constraints. Patients received 60 Gy/8 fractions (rather than the 10 fraction regimens questioned here) but the best data we have to extrapolate and use constraints that are ...
How would you approach adjuvant therapy for a patient with duodenal adenocarcinoma with ypT3 pN2 disease on Whipple resection after neoadjuvant FOLFOX x6?
I would offer postoperative chemoradiation. Duodenal primary cancers have more of a significant locoregional pattern of spread so logically, local control improvement could translate to a survival benefit.
How do you treat duodenal adenocarcinoma when using primary chemoradiation therapy?
We treat them the same as rectal cancer. Induction FOLFOX, followed by 50.4Gy in 28 with concurrent capecitabine. The responsiveness to these therapies is about the same, including cCR rate of 30% and ultimate LC without surgery 20%. There is no role for PET, we use CT CAP with contrast. The tumor +...
How do you approach treatment of brain metastases of varying sizes with SRS?
The UAB institutional paradigm has evolved to the following current practice patterns.Most patient's treatment plans are generated and delivered via HyperArc. Nearly all patients are treated on a Varian Edge with initial kv-kv, followed by CBCT/sim 6DOF alignment based on bony windowing with the VOI...
For patients with clinically node-positive prostate cancer, would you consider adding a brachytherapy boost to external beam radiation and ADT?
Absolutely not. Unless on a clinical trial.Not only are these patients excluded from every brachy trial, there is essentially zero retrospective data. Thus you have essentially no data that this will help the patient. However, what you know is that it will increase cost and increase toxicity.ASCENDE...
Would you modify your treatment approach for treating an HPV-positive head and neck cancer in a patient with symptomatic Sjogren's?
Patients with Sjögren’s syndrome have baseline xerostomia of variable severity. Management of Head and Neck cancer in this population depends on the location and stage of the primary. I would prefer to treat them with primary surgery if at all possible. If RT is necessary either as primary modality ...