Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For women with non-autologous breast reconstruction who require PMRT, is it better to radiate an implant or an expander?
Data suggests higher complications with RT to expander in comparison to implant but that itself is not the only driving factor. I don’t think there is one approach for this as it is a function of many factors including whether the patient would get chemo or not (enough time for expansion and replace...
For patients with solitary plasmacytoma of the ureter undergoing definitive XRT (40-50 Gy), what dose constraint do you use for the ureter?
Well, since this is a solitary plasmocytoma of the ureter, I presume that parts of the GTV encompass the OAR here. I do not think that you can set any meaningful constraint for the ureter, bearing in mind that this is a serial OAR. You can try to avoid hotspots in the ureter, but that's about it.
When do you recommend adjuvant radiotherapy for a resected oncocytic carcinoma of the submandibular gland?
Oncocytic carcinomas are rare, but known salivary gland entities. Likely many were present historically, but since morphologically distinguishing between salivary gland cancers needs pathologic expertise, it is likely that many were "misdiagnosed" as adenocarcinomas or other salivary variants. Few o...
For very large locally advanced head and neck primary malignancies (namely SCCa), how do you decide between adaptive re-planning of a VMAT/IMRT plan during chemo-RT as option instead of induction chemotherapy?
Like Dr. @Dr. First Last nicely noted, there is no survival benefit associated with induction outside of unique circumstances (such as NPC), so we would not routinely use it. Where induction could be helpful over adaptive VMAT/IMRT CRT, in our practice, are in circumstances for locally advanced HPV+...
How do you typically sequence chemotherapy and palliative radiation for metastatic endometrial and cervical cancers?
We have done it either way. Either start with RT for pain control or do it in between chemo based on the OAR dose and fractionation planned. If away for critical OAR dose and plan for single fraction, it can be done in between chemo also.
Would you offer PMRT for a small focus of invasive disease in a background of extensive DCIS?
I am assuming node negative with SNLN. Normally I don’t treat but would like to know the grade of cancer along with how many margins are close (how close defined in mm) and if close disease focal or diffused at the margin. If all the above are unfavorable then would consider chest wall RT.
When planning concurrent chemoradiation for locally advanced NSCLC, do you consider prescribing primary tumor disease to a lower isodose line, such as 75%, if OAR constraints for standard prescribing are met?
For stage III NSCLC, we routinely deliver 60 Gy to PTV with SIB 66 Gy to GTV in 30 fractions using IMRT with concurrent chemotherapy. Some clinical data indicated that primary tumors might need higher dose in order to achieve optimal local control. Therefore, it could be reasonable to consider an ev...
Is there a role for prostate cancer lesion boost with EBRT in the setting of combination EBRT+ brachytherapy?
I’m not sure if I see a significant rationale for employing an EBRT focal boost in addition to a whole-gland brachytherapy boost. If one were to want to deliver more dose with this treatment paradigm, it seems more dosimetrically efficient to boost the area with brachytherapy. Prior work has also re...
What techniques and dose constraints do you utilize to limit lower extremity neuropathy when providing post op radiation following soft tissue sarcoma resection?
What is your preferred skin surface maximum dose constraint for skin brachytherapy?
In a recently published study of electronic skin surface brachytherapy, we used a technique that delivered approximately 8.7 Gy per fraction to skin surface (125% of the prescribed dose of 42 Gy in 6 fractions of 7 Gy delivered to 3 mm depth from skin surface). This publication demonstrates the acut...