Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you boost residual lung disease after chemotherapy after whole lung irradiation for patients with Ewings, Rhabdomyosarcoma or Wilms?
A patient who did not undergone a resection for the gross residual pulmonary metastatic disease in either Ewings or RMS may receive a boost at the completion of the whole lung portion of their radiotherapy. It is infrequent that this occurs at our institution as our bias is to resect the gross resid...
For extremity rhabdomyosarcomas (hand) with positive epitrochlear and axillary lymph nodes, do you treat the lymph nodes or just the primary?
Treatment of extremity RMS (either hand or foot) requires either resection or radiation for local treatment, in the setting of effective systemic therapy. There are good data in the literature showing that the primary tumor can be effectively irradiated, while retaining function and form so to avoid...
In light of the DBCG-IMN study, are you treating internal mammary nodes in women with positive axillary LN who have path CR after neoadjuvant chemotherapy?
For those patients who have a CR after neoadjuvant therapy, there is considerable controversy regarding the need for any radiation after mastectomy or any regional nodal RT after breast conserving therapy. It is a setting of true equipoise given the available data. In fact, a recent analysis of radi...
When administering breast brachytherapy (10 fxs BID), is it critical that treatment start on a Monday (not straddle one weekend)?
NSABP B-39 allowed PBI to be given over 5-10 days, so we stay within this time frame and haven't seen any problems.
When do you employ post-op external beam radiotherapy in papillary thyroid carcinoma?
There are no prospective studies of post-op RT for thyroid cancer. Some retrospective studies suggest that RT significantly decreases the risk of local recurrence in cases where likely positive margins remain, mostly at the trachea margins. The benefit may exist even when pre-surgery there is eviden...
Is there a role for partial breast RT in DCIS?
To be frank, how long are we as a specialty going to navel-gaze about DCIS, be it APBI or hypofractionation (HFRT)? I mean, are these women ALL condemned to conventionally fractionated whole-breast radiotherapy (with a ***COUGH*** BOOST, no less!) in perpetuity because we don’t (and never will) have...
How do you treat limited stage small cell carcinoma of the lung after a complete response or near complete response to chemotherapy prior to radiation?
I advise treating patients with limited disease early, cycle one or two...then this issue never comes up.Waiting for radiotherapy until after many cycles of chemotherapy means the residual is likely resistant. We have never advocated delayed twice-daily TRT. We agree with the Dirk De Ruysscher/Maast...
What is the appropriate nodal coverage a invasive ductal carcinoma status post lumpectomy with 50% or more of the SLN biopsied (for example, 2 of 4 SLN) showing micrometastases?
I don't know what 50% or more for SNLN means, as knowing absolute number of nodes is more important as median number of SNLN dissected is usually between 1-2 . The treatment volume in patients with micromets is highly variable across practitioners- from no adjustment of field (based on IBCSG 23-01) ...
What is your preferred approach for late recurrence at a primary site only of a limited stage small cell lung cancer initially treated with chemoradiaton?
"Late" recurrences of small cell lung cancer are unusual. For example, brain metastases very rarely develop after 3 years, and most have developed by 2 (NEJM 1999;341:476). A similar pattern has been observed for local disease (JCO 1997;15:3030). Thus, one must be suspicious when a "late" recurrence...
What adjuvant therapy recommendations would you make for a patient with pT3N0M0 duodenal cancer?
The is not enough data to guide you on this question because duodenal cancer is an orphan disease. So, all you have is first principles and extraploation from similiar clinical senarios with more data. Duodenal cancer has a similar responsiveness to XRT as rectal and gastic cancer (pCR rate is about...