Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For linac based fractionated radiosurgery (5 fx) to a brainstem metastasis, is there a dose constraint for normal brainstem outside of the target volume?
More data are needed on brainstem tolerance for multi-fraction SRS. I use the AAPM TG101 suggested constraints of <0.5 cc >23 Gy and <0.035 cc >31 Gy. For metastases, one could certainly consider exceeding these constraints, as tumor recurrence would result in similar (if not worse) potential functi...
Would you offer post-operative radiation for a glomus tumor of the spine following decompressive laminectomy and incomplete resection?
[68Ga]-DOTATATE PET/CT has demonstrated excellent diagnostic value in the localization of SDHx-related and sporadic head and neck paragangliomas. Significantly more lesions were identified on [68Ga]-DOTATATE PET/CT compared to all other functional and anatomical imaging modalities Janssen et al., PM...
Is ASTRO's recommendation to avoid whole brain radiotherapy following SRS for limited brain metastases practical for patients treated in the community setting?
Agree, YES! But, can I elaborate? :)No evidence has ever indicated any benefit more than local/elsewhere brain control for WBRT. The addition of WBRT to surgery didn't change overall survival, and enough retrospective data indicates cognitive side effects. Patchell's trial used 50.4 Gy in 1.8 Gy fra...
Does radiation offer a benefit for knuckle pads due to Dupuytren's?
Knuckle pads have similar histology to Dupuytren's and may be called dorsal Dupuytren's nodules or Garrod's disease (PMID:31184950). Radiotherapy is effective for early-stage Dupuytren's and 10 patients with Garrod's disease were irradiated in the large German radiotherapy study, but results for tha...
How do you typically prescribe dose to a PTV for standard IMRT plans?
Each PTV has three constraints: >/= 95% of PTV receives 100% of RX dose Max hot spot </=110% >/=99% of PTV receives >/= 93% of Rx Dose
How would you approach patients with primary cardiac sarcomas for adjuvant systemic treatment?
Majority of these primary cardiac sarcomas tend to be angiosarcomas or UPS-variants. They inherently have a poor prognosis with high risk of metastases and death. Adjuvant XRT is generally difficult in this location. These also generally affect young individuals with o/w good PS/organ function. So w...
In what situations (if any) would you recommend ENI for a low grade parotid mucoepidermoid carcinoma?
Not sure if I understand the question correctly but I will give the best answer I can. There aren’t many reasons to treat low-grade parotid mucoep. If you’re treating for positive margins only, I wouldn’t do ENI. If you’re treating for PNI, cover nerves to skull base. If there are positive nodes, tr...
How do you decide between high tangents or regional nodal radiation in patients with small, ER+ breast cancers who have a single positive sentinel node?
I tend to look at factors such as age, LVSI as well as number of SLN (1/1 vs. 1/2,3,4). After lumpectomy, for cases like this, my bias is to offer whole breast and RNI. I have also started offering more 40/15 to breast and lymph nodes so this approach doesn't lengthen course of treatment as compared...
When using chemoRT for bladder preservation in muscle invasive bladder cancer after maximal TURBT, how should the mid-point (40 - 45 Gy) cystoscopy be utilized?
The thought is that medically inoperable patients go straight through (since no point in evaluation, b/c they won't be getting cystectomy), but for medically operable patients, they may be better served by cystectomy after a cystoscopy that does not show a CR, and that has been the RTOG approach. Ho...
In what scenario would you recommend induction chemotherapy prior to chemo-radiation in head and neck cancers and what would be the preferred regimen?
The use of a sequential approach to treating locally advanced SCC of the head and neck is not generally recommended since three studies from Spain, the Dana Farber Cancer Institute, and the University of Chicago failed to demonstrate a survival benefit from three cycles of TPF (platinum, paclitaxel/...