Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What surveillance imaging is appropriate after spine SBRT?
All of us have our own formulas. I tend to see patients about 2 months right after spine SBRT, then every 3-4 months thereafter. While most patients I continue with every 4 month follow up beyond two years, there are times that I space that out to every 6 months depending on the clinical circumstanc...
For a patient with inflammatory breast cancer after standard initial systemic therapy with only a partial response, do you recommend more systemic therapy, pre-operative radiation, or proceed to modified radical mastectomy?
The systemic therapy question was addressed and partly answered with the CreateX trial. In that 900 patient trial there was an improvement in DFS and OS with adjuvant capecitabine. The current EA1131 explores this question further, directly comparing cape to platinum. The randomization is stratified...
Do you offer hypofractionated accelerated whole breast radiation therapy for women receiving trastuzumab during RT, particularly those with left sided primaries?
In the modern era for breast RT the radiation field should not be transversing through heart (a conformal block, the prone position or DIBH technique can help prevent radiation to the heart) and with one of these techniques mean heart dose is 1 to 2 Gy (most of this dose comes from scatter or transm...
When should intermittent androgen deprivation vs continuous androgen deprivation be used for the treatment of prostate cancer?
I think the question posed and the patient example are really 2 different questions. To address the title question, let me call your attention to a recent article in the JCO 34: 280-5, 2016, and an accompanying editorial, which review this issue in detail. The authors point out that there are signif...
Is SBRT an appropriate treatment for recurrent and unresectable spinal ependymoma?
We have reirradiated a handful of patients who had 45-54Gy to the spinal cord 5-12 years ago with another course of RT 50Gy/25 to the cord without any neurologic sequelae--this is unpublished (we are working on it). We have also reirradiated small recurrences after a full course of RT to the spinal ...
Are there situations in which elective nodal volumes may be reduced for T1/T2N0 anal SCC?
I have treated several elderly patients with small tumors using this low dose, limited field regimen. All did well. Involved-Field, Low-Dose Chemoradiotherapy for Early-Stage Anal Carcinoma Paul Hatfield, M.D., Ph.D., F.R.C.R., Rachel Cooper, M.D., M.Sc., F.R.C.R., David Sebag-Montefiore, M.D., F....
In patients who are medically poor surgical candidates, what are the treatment options available for bulbomembranous urethral cancer?
The evidence is thin, but these patients may be treated by chemo-radiation. Whether they are urothelial cancer or squamous cell carcinoma the aim would be to get in a worthwhile radiation dose, say 65-70Gy, with reasonable sensitizing chemotherapy if they have the kidneys to tolerate it. Sometimes t...
Do you routinely boost focally positive margins after preoperative 50 Gy and surgery in patients with extremity sarcomas?
Even though it was done in the Canadian randomized study comparing pre operative vs. post operative RT, retrospective data suggest hows no additional benefit with this intervention. This is likely because dose of 16 Gy would not be sufficient for residual disease. Even though it is not relevant in t...
How do you minimize skin toxicity in patients who have a significant amount of breast tissue contacting the couch during prone breast radiotherapy?
In our center, we treat roughly 60% of patients post lumpectomy in the prone position. Larger volume breasts treated in the prone position do touch the treatment table requiring care that this position is reliably reproduced daily. In our experience we do not see additional acute or late toxicity wh...
Should consolidative RT for extensive stage SCLC be given before, after, or concurrently with PCI?
Great question, and to my knowledge there's not a lot of data to guide this so I dont think there's a wrong answer.Before the CREST trial, my practice was to do PCI first, because I felt that the evidence for an OS benefit was much stronger, and it was therefore more improtant to get this completed ...