Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does the RTA proposed legislation that would remove technical payments for freestanding radiation oncology centers from the Medicare physician fee schedule help or hurt radiation oncologists in a freestanding center?
While ASTRO supports payment reform, I personally cannot support this particular bill as introduced by RTA. My main concern is the unknown impact on the professional services fees for radiation oncologists practicing in BOTH freestanding and hospitals. So, to answer the question as it was specifical...
What dose and volume would be recommended for a medically inoperable patient with a T4 rectal adenocarcinoma?
As is so often true, there is no absolute answer to a general question of this sort. It is much less common nowadays for a patient to be medically inoperable with the major advances in anesthesia. That being said, these patients certainly do appear. There is not a good literature on the proper dose....
Do you treat inguinal lymph nodes for patients with low lying vaginal cancers?
Yes we do. For distal vaginal cancers (not involving vulva) that have no enlarged nodes, we treat the medial inguinal nodes (e.g. nodes medial to the common femoral and saphenous veins) to 45 Gy. We do not treat the nodes lateral to the femoral vein (i.e., along the circumflex v) unless there are su...
Should one perform a sentinel node biopsy in a clinically negative axilla prior to neoadjuvant chemotherapy?
For an upfront clinically and radiologically negative axilla, where the SNLN is negative for disease after chemo, we don't change our RT field. For an upfront clinically and radiologically negative or positive axilla where SNLN is positive even after chemo, then normally they undergo full dissection...
Is it safe and appropriate to palliatively treat abdominal or thoracic tumors with concurrent chemotherapy when using fractions of 250-300 cGy?
I have routinely given 250cGy per fraction to total doses of 3500-3750cGy with single-agent radiosensitizing chemotherapy (usually 5-FU or capecitabine) without apparent significant toxicity, though we have not reviewed our data. So I generally consider this to be a safe regimen and consider it for ...
What RT margins do you use when treating Grade III anaplastic gliomas?
At the Cleveland Clinic, we extrapolate from the GBM literature and from the Cairncross RTOG 9402 and Van den Bent EORTC trials showing the benefit of chemotherapy, and thus deliver radiation with concurrent temozolomide. We typically treat to 5940 cGy in 33 fractions. We treat PTV1 to 5040 cGy and ...
What is the most accurate method to determine initial tumor size prior to neoadjuvant chemotherapy and mastectomy?
The pattern of regression after neoadjuvant chemo is not always consistent. It could be concentric where the tumor regresses uniformally in all direction and thus the final tumor is unifocal and much smaller than imaging (percentage regression suggests the degree of response to chemo). Or it could b...
Do you re-irradiate for heterotopic ossification in patients who re-develop ossifications?
There is not much on this subject, but we have retreated patients using 7 Gy in 1 following revision surgery without any obvious detriment.
How do you manage patients with early stage breast cancer with autoimmune disorders such as rheumatoid arthritis and collagen vascular disorders?
The historical perspective has been to treat in 180 cGy daily fractions to a total dose of 45 Gy with a tumor bed boost (assuming the need) to 50-55 Gy based on intrinsic increased radiosensitivity of normal and tumorous tissues. It is unclear whether this dose-fractionation schedule is effective be...
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...