Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your radiation dose/volume for adjuvant treatment of a clear cell odontogenic carcinoma of the mandible after segmental resection?
CCOC is a rare aggressive tumor for which case-report reviews suggest recurrence rates of 30-50% following surgical resection. I would approach this tumor like I would poorly diff. Sqcca: targets including the resection bed with generous CTV margins (66 Gy), levels IA&B and IIA, and a few centimeter...
Are there additional risks associated with PMRT for a patient with prior lympho-venous bypass surgery?
Based on FABREC, we do offer hypofractionation after reconstruction and focus on plan quality with dose homogeneity and very selective use of bolus. RT CHARM will further clarify. LV bypass helps to reduce lymphedema risk and we don’t change fractionation based on that. Conroy, Cancer Network 2023
Would you offer whole breast RT in an elderly patient with early stage breast cancer with EIC?
EIC in-and-of-itself would not drive me to offer RT given that CALGB 9343 likely included patients with this finding, among other high risk features. I would, however, consider the constellation of risk factors in trying to place this patient on the spectrum of CALGB9343 risk. For example, a patient...
What data is used to show cystectomy is superior to concurrent chemoradiation for muscle invasive bladder cancer?
In the absence of valid randomized clinical trials, Stein et al., PMID 11157016 1000+ Rad Cystectomy is often considered the benchmark article for Urologists when addressing this question. The paper is from the pre-adjuvant chemo era so some will say the survival is actually 5 to 10% higher than rep...
Do you use a tumor-bed boost following whole breast irradiation for patients with DCIS?
Good question as we are lacking prospective data on this topic while awaiting TROG 07.01. In the absence of prospective data, I generally omit a boost in DCIS with the exception of women <50 with high grade DCIS (as per criteria used in RTOG 1005) or women with DCIS who present with a palpable mass.
Would you recommend PMRT using a hypofractionated course to the chest wall and nodes?
With recent publication of Chinese data with median follow-up of 5 years showing no difference in any end point, we routinely offer hypofractionation to patients 65 and above with non inflammatory breast ca and no immediate reconstruction. For patients who have reconstruction done or planned, we enr...
Is it appropriate to offer definitive trimodality therapy, as an equivalent option to neoadjuvant chemotherapy followed by radical cystectomy, in patients with muscle-invasive bladder cancer regardless of fitness or platinum eligibility?
There are now several retrospective studies utilizing advanced statistical techniques suggesting that outcomes after trimodality therapy (TMT) are very similar to those after surgery (e.g., Zlotta et al., PMID 37187202, Brück et al., PMID 37517601, and Kulkarni et al., PMID 28410011). These findings...
How would you manage a recurrent uterine leiomyosarcoma, now status post secondary cytoreduction, with no gross residual disease?
NCCN guidelines recommend that isolated metastases that have been resected can be considered for treatment with postoperative systemic therapy and/or postoperative external beam RT. Observation is also an acceptable alternative for those who have no evidence of disease on postoperative imaging. This...
What is your cutoff for the maximum number and size of brain metastases that you will treat with SRS?
Sadly, the level 1 evidence needed to truly delineate the greatest benefits from SRS will probably never be realized beyound what we already know: SRS shows an OS benefit to pateint with 1 intracranial met and a CNS-DFS benefit to 2-3 mets. Beyond that, it's better in terms of preservation of neuroc...
What is your approach to management of a subtotally resected pineal parenchymal tumor of intermediate differentiation (CNS WHO grade 2)?
In full disclosure, I have had only one adult patient with PPTID. Although PPTID was first described in 1993, it was not recognized by the WHO until the 2000 classification and represents only 1% of primary central nervous system tumors. Prognosis falls somewhere between that of a pineocytoma and pi...