Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are special precautions necessary for esophageal cancer with tracheal invasion prior to chemoradiation?
In addition to the standard staging workup for esophageal cancers including EGD/EUS and cross sectional imaging with CT and PET scan, modern guidelines also suggest evaluation of tracheal anatomy with bronchoscopy. It has been our institutional practice to consider this procedure in any patient with...
Is there evidence to support routine use of adjuvant chemotherapy for resected rectal cancer treated with pre-operative chemoradiation?
We settled this question in 1985 with the GITSG study showing chemo, or radiation were better than observation and the combination had the best survival (GITSG, NEJM 312,1465, 1985). Whether you administer radiation or systemic therapy before or after surgery is irrelevant but all three modalities h...
What is the preferred dose and fractionation scheme for patients with pituitary macroadenomas?
Radiation treatment approach for pituitary adenomas is dependent on several factors. This includes whether it is secretory or nonsecretory, and proximity to optic nerves/chiasm. Surgical resection should always be considered as the first approach (with the exception of prolactinomas, which should be...
When does a rising PSA after prostatectomy indicate growth just of normal prostate?
The concept of residual prostate tissue after prostatectomy has been around since the advent of the PSA. The idea that BPH could exist within this residual tissue has been suggested for nearly the same amount of time. Very little data exists regarding this concept. It has been demonstrated that resi...
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...