Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the best radiation dose to treat primary cutaneous B cell lymphoma?
For a small (1-2cm lesion) of these subtypes, 30Gy is usually adequate. For larger/thicker lesions, consider 36Gy. Electrons with bolus or orthovoltage/superficial therapy.
What is the shortest interval you would consider to deliver re-irradiation for a recurrent glioblastoma?
Re-irradiation (assuming infield local progression) doesn't usually get discussed until more than 6 months following initial radiation therapy, likely because any increase before that is going to be possible pseudo progression. But after that point if there is increasing contrast enhancement suspici...
What is the best dose to treat splenomegaly with pancytonenia in the setting of myelofibrosis?
I have treated occassionally and have recommended 20 cGy to 25 cGy alternate day x 3 or 4 fractions It works well as spleen is a very radiosensitive organ and does not require doses above 150 cGy
How do you choose between moderate hypofractionation vs SBRT for intact low or intermediate risk prostate cancer patients?
In low-risk prostate cancer patients, hypofractionated regimens have been proven to be equivalent to standard fractionation in randomized studies (e.g. RTOG 0415 - Lee et al., PMID 27044935). Mulitiple non-randomized studies have shown that SBRT appears to have comparable results to historical contr...
How would you treat a p16+ small cell neuroendocine tumor of the anal canal with or without metastatic inguinal lymph node metastasis?
Interesting case. Small cell cancers are generally considered radiosensitive, but so is anal squamous cell carcinoma. I personally would do the same RT field and dose. The real conundrum for me is the concurrent chemotherapy regimen - do you keep 5FU/MMC or do you use cisplatin/etoposide? I think a ...
How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?
Engage your Pulmonology colleagues to assist in these difficult cases. Important to rule out other causes of persistent symptoms including infectious processes. Rebronch can be helpful for infectious work up and/or determining the nature of the inflammatory process that is ongoing (for example, the ...
Would you recommend radiation therapy for a pathologic vertebral compression fracture already treated with kyphoplasty and RFA (OsteoCool)?
Assuming there is active disease in the vertebral body in question, I would recommend radiation therapy. An abstract was presented at the last ASTRO describing a retrospective small series from Roswell Park (Prezzano et al) suggesting that the combination of RFA and RT was beneficial for spine metas...
What duration of ADT + abiraterone do you recommend prior to initiation of HDR brachytherapy followed by EBRT for very high risk localized cT3bN0 prostate cancer?
This is a short answer (for me) given the lack of data to support brachy boost in T3b disease in a randomized trial.The only randomized multicenter trial comparing dose-escalated EBRT to brachy boost is ASCENDE-RT. They specifically excluded T3b patients (see supplementary content for all exclusion ...
How do you plan prostate radiation in a patient with a sacral nerve stimulator?
I have treated a few patients with pelvic nodal RT with sacral nerve stimulator and just asked it to be switched off during CT sim and daily RT.
How do you approach adjuvant radiation for perihilar cholangiocarinoma?
There should certainly be multi-disciplinary discussion, as while RT can augment locoregional control in the adjuvant setting and should strongly be considered, there is a paucity of high-level data. SWOG 0809 was the first prospective study (single-arm phase 2) of adjuvant therapy in stage pT2-4 or...