Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does finding a positive surgical margin containing pleomorphic LCIS in a patient with early-stage invasive ductal carcinoma of the breast affect your management in regards to breast conservation therapy?
Based on limited data, we treat PLCIS with the same principal as DCIS and aim for a negative margin and offer adjuvant RT. PLCIS presents with microcalcs like DCIS and in the pre e-cadherin staining era, they were called DCIS and included in the old NSABP study as DCIS.
Is hypofractionation ever appropriate in women with early stage breast cancer and latent lupus who have never experienced skin symptoms in their lifetime?
Short answer: Yes. I do offer HFRT to such patients. No. I would not advise a "wait-and-see" approach. Long answer: There are actually two categories of considerations here: First, are you comfortable treating patients with autoimmune/collagen vascular disease (CVD)? If so, are you a "lumper" or a ...
What technique, total dose, and fractionation do you use for DCIS following lumpectomy with <2 mm negative margins which are not re-excised?
We use 50Gy/25fx and 10Gy/5fx boost for DCIS pts with close margins. Post -lumpectomy mammograms should be obtained to rule out residual calcifications.
What are the advantages and disadvantages of concomitant versus sequential boost for treating cancers of the head and neck with IMRT?
Concomitant boost IMRT requires just one, while sequential requires two plans (disregarding the possible need for adaptive re-planning, which would be the same in both). BED2 doses to the targets and to specified organs are expected to be similar, however, the doses to the non-defined tissues are hi...
How do you advise patients on the risk for permanent alopecia following RT to the scalp?
If you are treating the skin in a certain area to definitive dose with RT for a skin primary, the patient is almost certain to have a patch of alopecia in the area of treatment. Regarding dose constraints, one older study by Lawenda and colleagues looked at 26 patients treated for CNS primaries and ...
What dose do you recommend for salvage radiotherapy after biochemical recurrence in prostate cancer?
We normally give dose of 66.6 Gy which should be sufficient for microscopic disease. In patients where there is imaging suggesting recurrence or the pre-RT PSA is high then we consider going to 70 Gy for a high volume of disease while taking normal tissue dose into account.There is data for dose esc...
How do you deal with wounds in or around the radiation fields?
Agree with @Dr. First Last completely. As another example, a slowly healing drain or mastectomy wound that remains open during chemotherapy will often close during radiation, despite being within field. I monitor and continue standard wound care, but do not change my treatment fields.
If a patient with a seminoma fails after chemotherapy in the paraaortic nodes, what is the best salvage therapy - different chemotherapy or radiation?
It depends on what the prior intent of chemotherapy was, what type it was, how confident you are that the patient has indeed relapsed as well as the size of the nodes. Three scenarios might be considered. If the patient received adjuvant carboplatin, somewhere between 5 and 10% will relapse and 75% ...
How do you approach treatment for isolated vaginal cuff recurrence of endometrial cancer in a patient previously treated with adjuvant vaginal cuff brachytherapy?
We take previous brachy dose into account. If the patients have a CT based plan from their previous brachy, then we calculate the 2 cc dose to rectum and bladder from previous RT. Based on that dose, we deliver 30-36 Gy to pelvis including entire vagina, paravagina and nodes with EBRT, and after tha...
When giving palliative lung radiation to a patient on immune checkpoint blockade for NSCLC, do you hold immunotherapy?
Most of the palliative lung RT regimens include either 3000 cGy in 10 fractions using 300 cGy per fraction or 3500 cGy in 14 fractions using 250 cGy per fraction. As the experience is limited on the concurrent use of palliative RT with immunotherapy, I withheld immunothearpy while treating the lung ...