Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer SBRT in a patient with history of CRC, subsequently found to have a solitary liver metastasis treated with chemotherapy followed metastasectomy with positive margins?
This is a difficult scenario, as there is little data to guide whether we should be radiating adjuvantly post metastectomy. My answer to this question would be, it depends. The rationale for offering adjuvant radiation in the setting of an R1 hepatic metastatectomy is based on multiple studies that ...
Is there a maximum time delay in offering adjuvant radiation to patients with wound healing issues for sarcoma and skin cancer patients with aggressive histology and positive margins?
A recent large NCDB review of 35,000 patients with resected nonmetastatic HNC who underwent postop RT found that the interval from surgery to the end of RT was a significant factor in overall survival, with interval of 11 weeks or less conferring best survival compared with longer intervals, especia...
Would you consider palliative RT in the setting of tumor causing osteonecrosis in an elderly patient?
If previously unirradiated, it is not osteonecrosis, it is cancer invading bone. Yes, I would. If previously irradiated, it’s palliative reRT and, yes, I probably would.
Do you recommend hypofractionated radiotherapy for elderly and/or poor KPS patients with diffuse IDH-mutant grade 2 glioma by extrapolation from high-grade glioma trials?
I am not aware of any trial for this specific scenario. However, hypo-fractionated radiotherapy with a higher dose per fraction and a lower total dose (for example, the Rao regimen of 15 × 2.67 Gy) is appropriate in older patients (>65–70 years of age) and in those with a poor prognosis (typically d...
Does incidental seminal vesicle invasion on RT planning MRI for an otherwise cT1-T2 patient influence your recommendation on ADT or pelvic fields?
The finding of seminal vesicle invasion on either a diagnostic MR or planning MR would definitely raise concerns for more advanced and aggressive cancer than a DRE staged cT1-T2 prostate cancer. In most cases, there may be other indications of tumor aggressiveness that would precede an incidental fi...
What is the general treatment paradigm for resected mucosal melanoma of the head and neck with respect to targeting and dosing?
Terrible prognosis rare disease without an established standard of care.Surgery followed by PORT is the general rule of thumb.Cover op bed + elective neck nodal RT based on location of primary.Dose: 60 Gy in 30 fx + boost as needed.There is a nice review article in the Red J from 2014 led by Richard...
Does your treatment approach for NK/T cell lymphoma of the nasal cavity differ depending on the volume and extent of disease?
There has been a recent (2021), updated review of treatment guidelines published by ILROG which provides very detailed recommendations including some considerations about systemic therapy. Qi et al., PMID 33581262.They offer treatment field suggestions based on the anatomic location of the tumor, di...
What is the appropriate treatment for a low lying rectal cancer in the setting of prior definitive prostate IMRT?
As is true for most complicated clinical situations, there is not any absolute answer to this question.First, it does allow me to remind everyone that prostate radiation therapy increases the incidence of subsequent rectal cancer- probably about 2 fold. This shouldn't surprise anyone, but it is some...
How would you manage sarcomatoid carcinoma of the prostate with poorly differentiated adenocarcinoma that is not amenable to surgery?
There is data on this rare histologic variant, albeit limited, and often in these situations we try to extrapolate from analogous areas with more data.It is believed that the pathogenesis of these tumors, the epithelial and sarcomatoid components, arise from a single cell of origin, rather than sepa...
Would you re-irradiate a spleen with increasing splenomegaly for a patient with myelofibrosis?
Would you care to elaborate a bit more on why such a dose was chosen during the prior treatment and what the result was? Other than that, I would re-irradiate, however with a low dose, starting with fractions of 0.5-1.0 Gy every other day, and giving the spleen some time to shrink.