Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you treat rectosigmoid/upper rectal cancers with neoadjuvant chemoradiation?
The 12-year update to the phase III pre-op RT Dutch rectal trial found a local control benefit with RT regardless of location (VanGijn et al., Lancet Oncol. 2011; 12(6):575-82.). In the Dutch update, tumor location was analyzed as a continuous variable. This is different from the every 5 cm cut-offs...
What dose and expansion of GTV is recommended for a low grade glioma?
I think doses between 45-54 Gy are probably reasonable for low grade gliomas when electing to treat with RT. Several studies have not shown a benefit with dose escalation in the treatment of low grade gliomas (EORTC 45 Gy vs 59.4 Gy; Intergroup 50.4 Gy vs 64.8 Gy). In terms of treatment volumes, RTO...
What is the ideal time interval to wait before starting radiation for postoperative treatment of benign brain lesions?
The answer to this question may vary by tumor type and expected tumor growth rate, but since meningioma was first among the cited examples, permit a brief comment with that in mind. For meningioma, likely quite similar to acoustic neuroma, pituitary ademona and other typically slowly progressive CNS...
How do you approach lung tumors with vessel encasement, especially in someone with active hemoptysis?
It's a good question and not one that has a ton of published data to support. If you look at the GYN literature for palliation of vaginal bleeding, hypofractioned RT can be a very useful treatment, suggesting a role in other sites. My impression is always that those are very vascular malignanies and...
Is there a role for consolidation radiation in a patient with stage I low grade follicular lymphoma treated with chemotherapy?
First, while there is no "standard" treatment for stage I follicular lymphoma due to a scarcity of randomized studies, most North American and European guidelines indicate that the "preferred" treatment is radiation therapy. This is based on several single institution series demonstrating that radia...
Does the molecular subtype of breast cancer influence your decision to give hypofractionated radiotherapy?
I heard Jay Harris speak at ACRO last year and the Dana Farber/Brigham has a personalized BCT approach based on molecular subtype ‘Personalized’ BCT based on Subtype, Age (DFCI/BWH) Luminals Age > 60: 266 x 16, no boost Luminals Age 50-60: 266 x 15, 250 x 2 HER2+ Age > 50: 266 x 15, 250 x 4 < 50:...
What dose do you feel comfortable treating the entire circumference of an extremity to before you are concerned about chronic toxicity?
The doses for lymphoma will depend on the histology , use of chemotherapy , response to chemotherpy . I am comfortable in giving 3600cGy at 180 cGy per fraction .
How do you manage cranial radiotherapy in the setting of an acute CVA?
Location of the infarct is important to consider, like brainstem or cerebellum or MCA areas apart from functional status. Lesion (infarct) volume (measured on DW-MRI) is an objective surrogate marker for infarct resolution [Gaudinski et al., PMID 18635854]. Either a SPECT or PET/CT scans can be used...
How do you determine whether to offer whole lung radiation to children with favorable histology Wilms, lung metastases, and a CR on chemo, without knowledge of 1p16q status, as per the AREN0533 protocol?
With very small lung metastases to begin with , I would withhold whole lung radiation if a CR is achieved with chemotherapy.
Does the RTA proposed legislation that would remove technical payments for freestanding radiation oncology centers from the Medicare physician fee schedule help or hurt radiation oncologists in a freestanding center?
While ASTRO supports payment reform, I personally cannot support this particular bill as introduced by RTA. My main concern is the unknown impact on the professional services fees for radiation oncologists practicing in BOTH freestanding and hospitals. So, to answer the question as it was specifical...