Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the optimal treatment for adenocarcinoma of the vulva?
I don’t know what is optimal but usually, they are associated with Paget's disease or Bartholin gland tumor and we follow the surgical principle same as SCC followed by adjuvant RT as indicated based on margin or nodal status.
How do you deal with the brachial plexus in head and neck cancer radiation (ie suprglottic larynx) when there is a positive node near the plexus or when you have an involved nodal level that you want to take to a higher dose?
I treat the cancer to full dose. If the patient is suitable for a neck dissection you could possibly give 60 Gy and plan to add a neck dissection. However, if treating gross disease or positive margins, go to 70 Gy.
For what duration should abiraterone be used in a patient with biochemical and pelvic node recurrence (N1M0) who had prior definitive therapy with either RP or RT?
This is a similar but slightly different question than the one answered by Attard et al., PMID 34953525. This meta-analysis of randomized trials demonstrated a survival benefit with the addition of 2 years of Abiraterone + ADT compared to ADT in men who received definitive management for N1 prostate...
Would you use abiraterone or docetaxel in addition to ADT and radiotherapy for patients with very high risk, node-negative prostate cancer?
The most recent update from STAMPEDE's abiraterone arm in the M0 N0 very high risk setting was reported here: Attard et al., PMID 34953525 and strongly suggests that abi/ADT for 2 years plus radiation improves MFS and OS significantly and should be standard of care for men who are choosing RT in thi...
What strategies do you use for dose escalation when irradiating patients with inflammatory breast cancer?
I usually treat with conventional 2Gy to 25 fractions followed by 10 gy boost to scar area. In patients with a poor response to chemo, consider increasing the boost to 16 Gy. If they have any prechemo nodes like IM node or supraclav nodes, then boost the involoved node to higher total dose of 56 to ...
For patients with triple negative breast cancer who are planned to receive adjuvant pembrolizumab, would you recommend pembrolizumab be held until radiation is complete?
This will become a practical issue for radiation oncologists as four drugs are now approved for adjuvant treatment after neoadjuvant chemotherapy including pembro, xeloda, T-DM1, and olaparib. Out of these, olaparib and xeloda were done sequential after radiation as concern about increased side effe...
How do you treat synchronous rectal cancer and prostate cancer?
There are several case reports describing the treatment of localized synchronous prostate and rectal cancer. Combined radical retropubic prostatectomy and rectal resection has been described but is associated with high morbidity (Klee et al.). Definitive external beam chemoradiation therapy with 5-F...
What fractionation and dose constraints do you use for prostate SBRT?
UCLA King Protocol8 Gy x5PTV 95% of PTV volume to get 95-110% rx doseRectum V50 (20 Gy) < 50%V80 (32 Gy) < 20%V90 (36 Gy) < 10 %V100 (40Gy) < 5%BladderV50 (20 Gy) < 40%V100 (40 Gy) < 1.1%Femurs V40 (16 Gy) < 5%Small Bowel V50 (20Gy) < 1%
How would you manage a radiation induced sarcoma of the spinal cord following R1 resection?
Sarcomas, whether radiation-induced or spontaneous, require doses in excess of 60 Gy to control following R1 resection. In this case, the challenge is also associated with the fact that this area of the spinal cord was treated 40 years earlier with presumably cord tolerance doses for an ependymoma. ...
What volumes would you cover in a young patient with otherwise low risk breast cancer in whom the sentinel node failed to map and ALND was not performed?
I would favor high tangent including levels 1 and 2 in the field.