Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For elderly patients who cannot tolerate chemotherapy, is radiation alone an option for a stage IA favorable classical Hodgkin lymphoma?
In my experience, it has been extremely unusual that a patient with Hodgkin lymphoma is considered a non-candidate for chemotherapy. But I suspect that in community practice that situation may arise because very infirm patients are not referred to major centers and community oncologists may be a bit...
What criteria do you use when deciding whether to offer radiation for thyroid associated ophthalmopathy?
I can say that over the years, I have treated less than a hand full of these kind of cases. All have had excellent responses to the RT too. (I have not had to re-irradiate any....) In any event, the rule for me is, or, has been, is that if the patients were referred from the Opthalmologist (typicall...
What is the recommended treatment volume for residual or recurrent pituitary adenoma after resection?
I usually do just the gross disease for conventional and SRS.
Can SIB technique be used for GBM treatment?
I have done a lot of SIB when treating GBM. I would deliver 5000 cGy in 25 fractions to the T2 abnormality with a 1 cm margin, while simultaneously giving 60 Gy in the same 25 fractions to the T1C+/cavity region with a 1 cm margin. It cuts off a week of treatment that I think patients appreciate bot...
Would you consider a third course of radiation to the same site for late lung cancer in-field recurrence?
There are several important issues to consider before you even considering treating this patient1. Are you sure it's a recurrence? If PET/CTs are used for follow up, false positives are very common. It is vital to ensure there is nodularity (more likely to be a recurrence). Offering a course of anti...
Are there any cases for which you would limit the dose to the scapula or ribs when treating the breast/chest wall and regional nodes?
Dose to ribs should be limited in cases of reirradiation, where the risks of chronic chest wall discomfort, rib fractures, and bone necrosis are increased. Nonetheless the risks of serious toxicities with reirradiation appear to be low, based on a multicenter retrospective review (Wahl AO, IJROBP 20...
How do you decide between initial radiotherapy vs systemic therapy in patients with metastatic melanoma and brain metastases?
An interesting question the answer to which is changing!For discussion we will assume that the patient is not previously treated. Presence or absence of CNS symptoms is likely the most important way to dichotomize these patients. Other issues include number and size of the brain metastases, whether ...
What dose-fractionation schedule do you utilize to treat a locally advanced, symptomatic breast mass in a patient with metastatic breast cancer?
Understanding that this is palliative treatment, I have used the hypofractionation schemes used in England and Canada. If you believe that you can convert this to a toilet mastectomy, I deliver 50 Gy in 25 fractions. I have used capecitibine or cisplatin, based on whether this is triple negative or ...
Is breast conservation therapy appropriate for mutation carriers?
While most breast cancer patients who are mutation carriers elect mastectomy, breast conservation is an appropriate treatment option. Patients should be counseled that although their overall survival is comparable whether they are treated with BCT or mastectomy, their risk of local failure is higher...
In the modern era, what volume of involvement is considered limited stage SCLC?
The TNM staging system (7th ed.) for lung cancer, which is the standard by which small cell lung cancer should be now staged, includes contralateral hilar and supraclavicular nodal involvement under the N3 rubric, resulting in a global stage IIIB designation. Most oncologists would thus consider the...