Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with otherwise low-risk prostate cancer, does presence of a small component of Grade Group 3 disease up-stage to unfavorable intermediate?
I agree with Dr. @Dr. First Last's response and will just add a couple of additional thoughts. There are many things that go into making a decision about whether treatment is necessary, and what type of treatment is performed. In this case, it's important to consider patient factors (i.e. age, co-mo...
How do you follow up a patient with esophageal adenocarcinoma who is not a surgical candidate after finishing chemoradiation?
I am assuming that this patient has adenocarcinoma and also had definitive dosing radiation (50.4 Gy +) and not neoadjuvant dosing as was used in the CROSS trial (41.4 Gy). If that is the case, you would use the same surveillance as you would after surgery which is H&P every 3-6 mo with labs and sca...
What elective nodal areas do you cover in medically inoperable endometrial cancer?
Gebhardt et al., PMID 28923412 Schwarz et al., PMID 26186975 For early stage grade low volume grade 1 and 2 treated with brachy alone like the above reference. For those who need EBRT (for large volume or high grade), I usually treat common iliac, external, internal, and obturator nodal regions.
If you are unable to meet V50% dose constraint for partial breast irradiation, do you revert to whole breast treatment?
I believe you are referencing the V50 constraint in 5 fraction PBI based on the uninvolved breast volume.In cases where this is the situation, I first see how much I am exceeding the criteria by, if it's not a lot, I will consider proceeding with 30/5. If it's significantly exceeded, one option I co...
How would you manage a patient with synchronous locally advanced rectal adenocarcinoma (T3N2) and a large T2N0 adenocarcinoma of mid and distal esophagus?
A tough situation no doubt. Def need an MDT agreement with medical oncology and surgery. The patient should be evaluated for surgical (especially esophageal resectability). I am going to try to be creative here : I would vote 5x5 to rectal mass then get on mFOLFOX6 based chemo per CALGB 80803 trial...
How do you modify your dose constraints when giving lung SBRT to a new lesion in a patient previously treated with lung SBRT?
Hi @Dr. First Last. I don’t usually change it for lung constraints with a few caveats. Here’s the way I think about it, more or less…First of course, is the patient. How’s their lung function? Are they on O2 or limited in their ADLs? That raises the bar for treatment and constraints. Could they tole...
How should you work up calvarium or other osseous lesions when found during the initial staging of a patient with a new diagnosis of NSCLC otherwise non-metastatic?
In general, I try to "prove" metastatic disease to ensure appropriate staging. I have had several situations where a skull or other osseous lesion is suspicious on CT and have tried to assess by PET or NM bone scan - ultimately though, have referred for biopsy and have actually diagnosed several int...
What is the ideal interval to wait after surgery before starting external beam PBI treatment?
I typically wait 2-3 weeks to simulate and start anywhere from 3-5 weeks post-surgery as long as they are well healed.
What is the treatment strategy for a resected atypical endometriosis mass in the parametrium that has grade 1 endometrioid adenocarcinoma, in patient who had prior elective hysterectomy/BSO?
Based on the information, would favor pelvic RT unless high risk from adhesions from endometriosis as adjuvant treatment.
What is the best treatment for pT2 cN1 seminoma with mild elevation of B-HCG (~100)?
I would recommend making sure that the pathology is seminoma (with either review of the orchiectomy specimen and making sure there are trophoblastic elements or a biopsy of the retroperitoneal lymph node) as the beta hCG level is getting close to the upper end of what I would expect from a seminoma....