Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should cN0 oral cavity cancers that are completely resected but have indications for RT ever receive elective nodal RT?
For the larger question of "should cN0 oral cavity cancers...ever receive elective nodal RT?", I base my decision-making on primary site location, depth of invasion, grade, perineural invasion and lymphovascular invasion. Floor of mouth primaries with >1.5mm depth of invasion should have a neck diss...
Is there solid evidence for the proper sequencing of tamoxifen/SERM and breast radiation?
My approach is like above with one more factor to be considered: some retrospective clinical data and basic science experiments suggest that the concomitant use of tamoxifen appears to increase radiation-induced pulmonary fibrosis. If patient has not started TAM, then I have her start after RT as th...
Do you treat pelvic lymph node positive prostate cancer with definitive radiotherapy?
Unfortunately, there is relatively little data to guide us in the management of clinically lymph-node positive prostate cancer. As mentioned above, previous RTOG trials included patients with clinically and pathologically positive prostate cancer, however, these only addressed the question of whethe...
What dose-fractionation do you use when treating primary NSCLC with oligometastatic disease?
The approach to the lung primary in a patient with a single brain metastasis is dependent in our experience on clearly defining the extent of disease in the chest. Thus, the unusual presentation of a single brain lesion with an isolated primary (i.e.,. no regional nodal or distant disease) in the ch...
Do you forgo adjuvant radiotherapy for men with pT3 prostate cancer who have significant urinary incontinence?
I agree that early salvage may be reasonably effective and thus one might carefully observe patients who are not ideal candidates for adjuvant RT. Both the RADICALS study and the RAVES study will examine this issue (timing of post-op RT further). Here's a recent summary of the RAVES trial: BJU Int....
For intermediate risk prostate cancer do you recommend short-term complete androgen blockade or LHRH agonist alone?
This is a good question with little data specifically addressing it. Anthony D'Amico et al. did a retropsecitve study of this issue in a cohort of high-risk patients who were treated with IMRT+brachy and showed complete blockade was associated with better prostate cancer specific mortality (Red J, 2...
In early well-lateralized SCCA of the tongue (pT1-2N0), should the contralateral neck be radiated?
We did a multi institutional analysis of this that was presented at Astro 2018, the manuscript will be out soon. It looked at patients with lateralized oral tongue cancer and showed a 6% contralateral failure rate even in node positive patients. We are comfortable omitting the contralateral neck if ...
In SRS treatment planning, can a dosimetrist take the place of a medical physicist?
Our program has used a physicist and the plan is signed off by a physicist for intracranial cases. For spine SRS cases, we have used dosimetrists, as long as it is overseen by a physicist. I don't believe there are any specific rules that does not allow a dosimetrist to do the planning, as long as i...
How do you manage parathyroid carcinomas with positive microscopic margins?
As parathyroid ca is rare and no reliable data about post-op RT exist, we have to extrapolate from common tumors about which we have data. If this was a sq.c.ca in the low neck, or thyroid ca, we would treat the primary site (positive margins) to 66-70 Gy and neck levels II-IV as well as VI and uppe...
Do you feel that HDR brachytherapy alone is adequate treatment for some intermediate-risk prostate cancer patients?
Based upon a nearly 300 patient retrospective analysis of intermediate-risk prostate cancer patients at GammaWest Cancer Services, the answer appears to be a simple "yes," and for nearly all intermediate-risk patients. We published this in the Journal of Urology in 2012, and did not intend to select...