Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your recommended radiation field for early stage vulvar cancer with persistent positive margins (T1a-T1b)?
I agree that if the inguinal region has been adequately addressed with negative sentinel node biopsies or with an adequate inguinal node dissection that includes the femoral and superficial inguinal nodes, we would treat only the primary site. However, in these cases, we make an active attempt to li...
What PTV dose heterogeneity do you accept for head and neck radiation plans?
Around 10% but then I'll take the optic chasm to 70 Gy plus in order to adequately treat the tumor. I have a patient under treatment now in that situation. So I do what it takes. If it requires more heterogeneity, so be it.
Would you treat an unresectable papillary thyroid carcinoma metastasis to the nasopharynx with skull base and perineurial invasion with radioactive iodine, radiation therapy, or chemo-radiation?
I would use external beam radiotherapy or even SRS if volume, size and location of the tumor permit. It is unclear if patient's thyroid cancer is RAI avid. Regardless, given skull base invasion, RAI alone may not suffice.
Have the results of LAP07 caused your institution to pursue more aggressive systemic therapy before radiotherapy in the treatment of pancreatic cancer?
Chemotherapy is the standard of care for locally advanced pancreatic cancer. There are two standard regimens, Gem/A and FolfirinOX. These regimens are modestly better then gemcitabine alone, but there is a clear barrier in median survival of 12 months. This will probably never be surpassed with chem...
When would a completion inguinofemoral node dissection followed by adjuvant RT (+/- chemo) be favored over definitive RT (+/- chemo) for SLN+ vulvar cancer?
The interim analysis of the GROINSS-V II trial showed a recurrence in 12.2% (10/82) of patients treated with radiation in the setting of positive sentinel lymph node biopsy for vulvar cancer. On subset analysis the risk of nodal recurrence was 2.2% for micrometastases (< or = 2 mm) and 20% for macro...
For patients receiving concurrent chemoradiation for anal cancer, what is your ANC threshold for holding radiation or switching to a boost plan to limit myelotoxicity?
I hold chemoRT for an ANC< 1.0. If the ANC does not increase in a two or three days then 1-2 days of g-csf will help. One thing to remeber - do not give g-csf the day the patient is receiving chemoRT.
How do you approach thoracic treatment volumes for limited-stage small cell lung cancer?
Usually finding a target in LD-SCLC (limited disease, small cell lung cancer) is not a problem. The early days was very much cookie-cutter including both above clavicle regions, both hila and down to diaphragm. When the Intergoup trial was conceived in the late 80's, there was a need to define volum...
Do you routinely use IMRT to spare the carotids for early-stage glottic cancer?
Not only can IMRT spare the carotids here, and as I recall Dr. Fuller and others at MDACC were one of the first to officially publish some results on this, but it also reduces acute skin toxicity. It should be dosimetrically apparent that if you go from an opposed lateral field arrangement to a 3-fi...
Do you routinely recommend adjuvant radiation for R1 resected paragangliomas?
I think it depends on location but in general I do recommend adjuvant radiation for R1 resected paraganglioma. For some patients, I'm comfortable with surveillance with the understanding that radiotherapy can be offered should there be any evidence of progression.
Would you consider omitting breast radiation in a male with early stage breast cancer who has undergone BCT?
We normally favor complete mastectomy and more so if BRCA2 is positive. This way we can avoid RT.