Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How are patients on anticoagulation managed in the context of intracranial SRS?
At our institution, we do not withhold heparin or warfarin prior to treatment. This risk of intracranial bleed is not felt to be increased as a consequence of treatment. We do use a traditional headframe (using pins to hold to the skull). While there may be an increased risk of bleeding at the pin s...
Would accelerated hypofractionated whole breast irradiation therapy be contraindicated in a patient opting for breast conservation in the setting of breast implants?
I would say it is not contraindicated. In the clinical studies comparing conventional to hypofractionation, they did not report any increase in late effects on skin or subcutaneous tissue. Rather, in START B it was less for hypofractionation possibly because of lower total dose. The most important a...
For post-op H&N cancers, do you get CT neck with contrast prior to sim?
I do not routinely order CT or MRI Neck prior to simulation, but our department is equipped to do IV contrast with our CT simulations. I try to use contrast with all of our H/N sims because it can help delineate target volumes, though it is not absolutely necessary. Our radiologists do not read our ...
How do you manage a peripheral NSCLC and a single positive contralateral lymph node?
In this circumstance, I would first confirm pathologically if possible with mediastinoscopy or EBUS. Right-sided tumors have a tendency to spread to ipsilateral lymph node stations only and spread to the contralateral mediastinum, particularly in the absence of ipstileral involvement, would be unusu...
Is weekly Cisplatin considered a valid alternative to Cisplatin cycles every 3 weeks as part of definitive chemo-radiation for muscle invasive bladder cancer?
None of the RTOG trials had this approach, but extrapolating from head and neck cancer (cisplatin 30mg/m2) or cervical cancer (40mg/m2), people in the community are using weekly cisplatin. As far as data, there is a phase II study from Australia utilizing cisplatin 35mg/m2 weekly for 6-7 cycles show...
For elderly patients with locally advanced rectal cancer who are not candidates for surgery or chemotherapy, what would be an appropriate palliative regimen?
There is an old paper from Princess Margaret Hospital ~1980, called "Is the Miles operation really necessary for the treatment of rectal cancer?". (Editor note: 1993 Update). These are patients who were medically inoperable or refused surgery. I believe doses were about 40 Gy. Remember that this was...
What is the best approach to management of newly diagnosed intermediate or high risk prostate cancer in a patient with high grade non-muscle invasive bladder cancer?
Perhaps the term "Best Approach" should be eyed with skepticism in the field of genitourinary radiation oncology. Is there extensive disease in the bladder, focal recurrences, or no visualizable lesions? The maintenance BCG element of the question suggests the patient has minimal measurable disease ...
Is there a role for post-operative chemoradiation therapy in fully resected, margin-negative T3N1 NSCLC?
I assume you're talking about T3 for chest wall invasion, and I think the answer is probably no routine role for RT for this individual risk factor. If you look at surgical series, invasion of the chest wall IS a risk factor for both positive surgical margins, and local recurrence. But if you limit ...
For breast cancer patients requiring staging, should one order a CT C/A/P & bone scan or PET scan?
For locally advanced disease (T4 or N2), I would favor PET/CT because of the higher yield for identifying metastatic disease. It is also important for the radiation oncologist because of the higher likelihood of identifying of involved IM nodes and level 3a and supraclavicular nodes which can change...
What dose do you typically use when retreating locally aggressive and recurrent SCCs of the scalp (with no regional or distant mets)?
Not much great data to support this contention, but my general practice is EQD2 of 70-80 Gy in a continuous course using shrinking field technique, depending on prior radiotherapy and tolerance of nearby organs at risk. For gross disease, concurrent systemic therapy may be worthwhile in patients tha...