Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there any role for adjuvant radiation for a low grade, intraductal papillary mucinous neoplasm (IPMN) of the pancreas after resection with a positive pancreatic margin?
There is no defined role for adjuvant treatment of IPMN with or without positive margins. This question illustrates an interesting concept that can be applied now that we are in the era where ablative doses of radiation can be given*. Regardless of the tumor site, the margin in question is not near ...
How often should a patients patient's pacemaker/ICD be interrogated while they are undergoing a course of radiotherapy?
There is no simple answer to this question. The frequency of the interrogation should made in concert with a experienced cardiologist/electrophysiologist. Factors that play into the frequency of interrogation include an estimation of the consequences of device failure and the likelihood of device fa...
What are your criteria to determine if there is a local failure versus post treatment changes after SBRT for inoperable early stage NSCLC?
A growing lesion with increasing FDG avidity at the site of previous SBRT is cancer unless proven otherwise. One must be careful though since some residual FDG uptake can last a year after radiation. PET is not terribly useful at the primary site until at least 6 months after SBRT.
For patients with brain metastases, do molecular subtypes influence your decision to use SRS versus whole brain radiation?
This is an excellent question and the decision of SRS or WBRT in this setting has significant clinical ramifications. All things being equal, in the situation as described, I would recommend SRS for up to 10 brain metastases in a patient with a good KPS and good systemic therapy options (targeted th...
Is there a field size in which you would consider single fraction palliative radiation unsafe?
There is nothing to suggest a larger field size when treating multiple body levels increases the risk of complications with 8 Gy single fraction. Radiobiologically it is less dose to cord than 30 Gy in 10 fractions. We routinely use it. Only if a large GI volume gets treated small bowel or stomach) ...
What are the appropriate dose-fractionation schedules for patients being treated with EBRT as opposed to SRS for an acoustic neuroma?
While we can argue about SRS versus FSRT all day, I think the data is slightly more clear with fractionation schedules. At Thomas Jefferson, my previous institution, we favored fractionation to 46.8 Gy in 1.8 Gy fractions for patients with serviceable hearing as this regimen has shown excellent tumo...
Can close surveillance be used to manage an intracystic papillary carcinoma that is associated with a small amount of low grade DCIS?
Intracystic papillary carcinoma, although by nomenclature is carcinoma, it has a behiavior like low grade DCIS and occurs in elderrly. Our treatment principle is very simailr to what one would do for DCIS.
What is the best way to peer review radiation therapy treatment plans within a department/clinic?
The is no single best way. Each radiation facility has its own unique strengths and weaknesses that will differ based upon staffing, specialization, intradepartmental culture, IT integration. I have worked in six different practice settings, and no single process will work for all. Key principles to...
For definitive fractionated RT of meningioma (presumed) without biopsy is it always necessary to treat edema evident on MRI Flair sequence?
Edema with meningioma is a complex issue, but appears in the vast majority of cases not associated with cerebral invasion by meningothelial cells. Clearly meningiomas can on occasion be brain invasive. This is now carefully defined as a WHO 2016 grade II criterion, but edema has not been shown to be...
In what situations do you consider adjuvant radiation for ovarian cancer?
Our understanding of the role of RT in ovarian cancer has been evolving. In most cases, the role is at most palliative because most ovarian cancers (particularly serous cancers) are widely disseminated at presentation. However, there is a subset of patients whose disease remains locoregionally confi...