Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose and fractionation do you use when you want an abbreviated course for incompletely resected squamous cell carcinoma of the pre-auricular area?
The answer to this depends on what you are targeting and in turn, the size of your target volume. If treating microscopic residual at the site of the primary (which was not larger than 2 cm), 35 Gy/5 fractions is the shortest course that is advocated by NCCN. For larger target volumes, consider 50-5...
Can chemotherapy be used instead of radiation therapy in a patient with extensive stage small cell lung cancer who presents with epidural spinal cord compression?
I think it would have to be done on a case-by-case basis, and the answer is likely "Not a good idea." Chemo can make SCLC shrink a lot, but you'd really have to monitor day by day with CAT scans. And it unlikely to take the pressure off the spinal cord arteries within hours to days, as is needed. Th...
When do you give treatment breaks for patients with NSCLC undergoing chemoradiation with serious toxicity?
I agree with @Dr. First Last's approach. I am very aggressive in not introducing treatment breaks during radiotherapy. One approach that I occasionally use to "make up" for dose issues when a break is inevitable is to accelerate at the end of treatment to make up for the break rather than to specifi...
How do you handle post-op, pre-radiation breast seromas and hematomas?
It depends on what I'm doing. If the patient is being treated to only the whole breast, like with the Canadian protocol, then I tend to do nothing. I just go ahead and treat. The hematoma usually won't resolve enough to change the volume over the three weeks. If I feel this patient needs a boost, th...
What is the best adjuvant treatment for resected NSCLC?
This is going to be a several part answer to a seemingly straightforward question. I’ll break this down into a few parts: 1) Which chemotherapy, 2) Targeted therapies in molecular subsets, 3) Anti-angiogenic agents, 4) The role of PORT (post-operative radiation therapy). 1. Which Chemotherapy: The s...
What is an acceptable SBRT dose for a central lung cancer encasing a coronary artery bypass graft?
As a Minnesotan, my immediate reply to your problem is "uff da, that's a tough one eh?". An image of the tumor location would really help here, but I'm going to presume it's maybe off the subclavian artery (longer course and may have more lung surrounding)? Either way, your patient is in a tough spo...
Does the literature support a benefit for whole lung irradiation for high risk rhabdomyosarcoma with multiple lung metastases?
My opinion is that there are no direct data. The European investigators are talking about doing a randomized study to investigate the value in intermediate risk patients. In US it has been standard for stage 4 pulmonary cases with RMS since WLI was established for patients with Ewings Sarcoma in IES...
In the modern IMRT/SBRT era, what should be the appropriate definition for the term "hot spot" in evaluating a plan?
The dose heterogeneity with IMRT has improved significantly over last 15 years. In past it was not unsual to see point hot spot (.03 cc) of 120% in PTV with a significant volume of PTV getting 110% or more.In modern planning with improved software and hardware usally point hotspot in majority of cas...
Would you treat the whole brain for brain metastases in a patient with active systemic scleroderma?
Any intervention which we do , we have to weigh pros and cons of treatmnent. For patients with brain metastases if untreated has worse acute consequences with potential neurodeficit vis a vis potential for late morbidity because of scleroderma. If feasible would do radiosurgery and if required would...
At what PSA do you start calculating doubling time post-prostatectomy?
The problem you describe, I think, also applies to standard assays when values are at or near the limits of detectability. Is an increase from 0.1 to 0.2 in 3 months really indicative of a rapid rise? If you are seeing small changes at low PSA values, and you're not inclined to treat the patient, yo...