Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of radiation therapy for an elderly patient with medullary thyroid cancer who is not a surgical candidate?
We have offered definitive RT for MTC patients who are medically or surgically unresectable. Dosing is variable based on involved structures, performance status, staging, etc. We have used 5400 cGy in 18 fractions, particularly for the more elderly, poor performance status patients. Coverage of elec...
What is the appropriate dose/fractionation when treating a dermatofibrosarcoma protuberans of the spine following debulking surgery in a patient with a good performance status?
Certainly, a challenging circumstance. With DFSP, pathology review is critical to evaluate for transformation to more aggressive variants with higher malignant potential. Clinically, DFSP is usually present for decades and extremely slow growing. Sudden changes in growth rate are concerning for tran...
What options do you have when a patient has urinary obstruction during radiation treatment?
Here is my general practice on urinary symptom management for a man with prostate cancer undergoing RT.Urinary symptom management RT can decrease urinary symptoms in men with irritable urinary symptoms (http://www.ncbi.nlm.nih.gov/pubmed/20643513) - not sure of mechanism but it takes time to see th...
How do you define your post-operative treatment volumes for a patient with a resected high-grade soft tissue sarcoma of the soft tissues of the upper back?
Thank you for this question. My concern with the lack of pre-surgical imaging is that there is not a good delineation of tumor extent. In scenarios of non-oncologic resection or resection without prior imaging, one should be wary of this. As such, my recommendation would be to be more generous with ...
Can venetoclax and radiation be safely given concurrently?
There is a recent retrospective review by Ho et al which looked at the toxicity profiles associated with "novel" oral lymphoma agents of ibrutinib, venetoclax, and lenalidomide concurrent with radiation treatment for lymphoma, as compared to sequential therapy of novel agent followed by RT (separate...
What dose do you use for single fraction SBRT when treating a small, peripheral early stage NSCLC?
There have been two randomized phase II studies of single fraction versus multi-fraction lung SBRT for medically inoperable early stage lung cancer patients. In RTOG 0915, 82% of patients were T1. In the Roswell Park Cancer Institute study, 86% of patients were stage IA. With that in mind, the curre...
What is the appropriate treatment approach for a primary squamous cell carcinoma of the trachea?
Treating tracheal malignancies is obviously challenging. I typically determine treatment based on the location of the primary. Upper tracheal (above the sternal notch) I treat more like a HN cancer while below that I treat more like a lung cancer. Upper tracheal cancer are more difficult to resect d...
What's your approach to adjuvant therapy for neuroendocrine (small cell) cancer of the parotid gland?
While it is rarely possible for a primary NE cancer to arise in the parotid, the vast majority of these are actually Merkel cell carcinomas (MCC) secondary to a skin primary in the draining zone of the parotid (or pre auricular nodes) in the face/scalp. Even if a primary were to be never detected, w...
How often do you believe para-aortic radiotherapy in addition to pelvic radiotherapy causes additional treatment breaks due to acute toxicity?
I would agree with @Dr. First Last that with IMRT and accurate definition of targets and organs at risk, that treatment can be delivered successfully. In patients who have had prior chemotherapy, attention to weekly blood counts is imperative. It is usually the platelet counts that pose a challenge....
What are your treatment volumes for patients with gastric cancer receiving adjuvant chemoRT for a positive margin following gastrectomy and D2 nodal dissection?
INT-0116 remains the only positive phase III trial showing a benefit to adjuvant chemoradiation for gastric cancer. Though very few of those patients had D2 dissections, unplanned subset analyses of 0116 and comparison to a contemporaneous Korean non-randomized trial in patients with D2 dissections ...