Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Why do we tend to boost grade 3 DCIS, but not grade 1 invasive disease?
For the same reason that a surgeon has to re-excise a 1 mm margin in a pure DCIS case, but that same surgeon does not re-excise a 1 mm margin on the DCIS that is associated with an invasive component...because guidelines.
In patients with newly diagnosed cervical esophageal cancer with limited metastatic disease, do you treat the primary with chemoradiation?
As systemic therapies for GI cancers have become more effective we are being asked to consider consolidative radiation. In general, radiation in this setting is for palliation only. However, in selected patients with limited M1 disease who have a durable response to systemic chemotherapy and the onl...
Is there evidence to suggest that whole pelvic radiation is immunosuppressive and may lead to worse outcomes in the setting of chemoIO treatment for stage III endometrial cancer?
There is data showing lymphopenia with pelvic RT but no outcome data showing it will have worse outcome with IO. Rather, a GOG study for concurrent chemo RT plus IO shows improvement in outcome in comparison to chemo RT alone leading to approval of the use of pembro for stage III and IVa cervical ca...
How do you sequence treatment for a patient following R2 resection of a large extremity leiomyosarcoma who has small lung nodules concerning for metastatic disease, but not yet biopsy proven?
In general R2 resection is not good news. I would first clarify with the surgeon, the barriers to a re-resection. If re-resection is feasible, then perhaps that should be attempted first. This patient is at high risk for local relapse, which ultimately leads to a poor quality of life. If the lung no...
Would you ever considering de-escalating therapy in any way for women with inflammatory breast cancer who had a complete pathologic response after surgery?
The first two options are reasonable but would not reduce the volume of treatment and would still consider for boost around the scar area even with hypofractionation.
Is there a role for consolidative definitive radiation therapy for metastatic rectal adenocarcinoma with good response to systemic therapy (patient is not symptomatic)?
Yes there definitely is. Patients with colorectal cancer are living much longer with aggressive treatment of metastatic disease and active chemotherapy. "Definitive" CXRT is really a neoadjuvant/palliative dose, 50.4 Gy in 28fx is the standard with 3D CRT. We would expect a 30% cCR and if that happe...
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...