Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is an appropriate dose for nodular lymphocyte predominant, stage 1 Hodgkin lymphoma following nodal excision?
We would treat to 30 Gy and treat somewhat more than involved site, as patients receive RT alone. This means treating more like involved region which, in this case, would probably be the ipsilateral groin nodal region.See the attached recent update from German group:http://jco.ascopubs.org/content/e...
How frequently should you order brain imaging after whole brain RT in patients not undergoing a planned SRS boost?
MRI every 3-m is recommended by NCCN and adopted by most insurance companies. However, more frequent imaging, such as every 2-m may be considered for melanoma, SCLC, RCC, or patients with large brain metastasis (> 2 cm), due to increased risk of progression after WBRT. Of course, MRI showed be done ...
Is systemic sclerosis an absolute contraindication for breast conserving therapy?
I see systemic sclerosis as a relative contraindication to breast conserving therapy/whole breast radiotherapy. There are a number of case series looking at whole breast radiotherapy in women with collagen vascular disease (CVD). While some of these showed statistically significant increase in sever...
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 ...