Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose is most appropriate when treating a post-prostatectomy patient with positive margins in the adjuvant setting?
The data for dose response in post RP radiation is not as robust as it is in the definitive setting. All randomised trials for adjuvant treatment used mainly 60 Gy, although retrospective data in the adjuvant setting shows better outcome with dose range from 61.5 Gy to 70 Gy. Similarly in the salvag...
At what point would Radium-223 dicholoride treatment be the best management for a patient with established metastatic prostate cancer with an elevated PSA and symptomatic bone pain with corresponding bone lesions on imaging?
At present, based on the randomised trial, it is approved for castrate resistant prostate cancer (can be chemo naive) with symptomatic bone only disease. In that situation, it improves all skeletal related events and survival and should be an indication to talk about this treatment. However, in prac...
Do you routinely include IMNs for left sided inflammatory breast cancer?
In our practice we radiate the IM in all PMRT. The recent studies that mildly favor regional nodal XRT including IM nodes in intermediate breast cancer make it hard to argue to do less in the most advanced. Reviewing studies of PET/CT in IBC provide a rough estimate of gross IM involvement in IBC of...
Do you administer prophylactic antibiotics during a partial breast balloon brachytherapy treatment course?
We do use prophylactic antibiotics to reduce the risk of infection. One multi-institution study with Mammosite (Cuttino et al in the Red Journal) suggested a reduced infection rate with the use of antibiotics.
Is there a role for post-treatment PET/CT following chemoRT for Stage III NSCLC?
The data from RTOG 0235 are certainly intriguing, but I don't think we have sufficient information to employ this in routine clinical practice.In fact, I think there are quite a few challenges, including, but not limited to:1. What is the true sensitivity for post-CRT PET/CT for LR failure? This was...
Do you ever recommend concurrent chemotherapy for high risk squamous cell skin cancer radiation?
Yes. The dose of radiation depends on the treatment scenario (adjuvant vs definitive). I generally follow NCCN guidelines, and give the same dose whether or not chemo is given. For bulky tumors, I might use a higher radiation dose if no chemotherapy is given. In general, the radiation dose is relat...
Do you use the PET scan hypermetabolic lesion to help contour the GTV for lung SBRT, especially in setting of peripheral atelectasis?
Merry Christmas/Happy Holidays Mednet. I'm sure there are faculty with a better set of credentials to answer this one, but since it's been on the list for a bit I'll compose yule log that can smolder in your mental hearths over the holidays. :) The short answer is yes. One of the commented benefits ...
What is the optimal management of recurrent seminoma with small volume retroperitoneal disease initially managed with surveillance?
The question is how to manage pathologic confirmed CSII seminoma. If the nodal volume is on the larger side (> 3 or so cm), most experts would treat those patients with BEP X 3 with a very high cure rate, with very low likelihood of requiring any post-chemotherapy interventions. Most experts in the...
What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?
It would be helpful to know the site of origin. Most stage I ALCL alk neg would be in the skin, in which case RT is the treatment of choice with little role for chemotherapy. Stage I ALCL, other then skin, would be quite rare with no data to guide us, except that we know response to chemotherapy for...
Do you treat fully resected squamous cell carcinoma of the ear with cartilage invasion with adjuvant radiation?
What were the margins? If sufficient (8-10 mm), I probably would not. I would certainly monitor the patient for lymph node metastases. Cartilage invasion is difficult to avoid for squamous cell cancer of the ear, so it is not surprising. Surgery is a better choice than radiation, unless so much cart...