Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you use IMRT in breast radiotherapy?
We seldom use it. Our limited dosimetric experience shows that even though coverage of regional nodes improves, the V10 and V20 of the lung and the mean heart dose also increase. Thus, the small benefit of improved coverage (EORTC and Canadian data showed small improvement in DFS) has to be weighed ...
Is acute pancreatitis a contraindication to radiotherapy for patients with pancreatic cancer?
No, it is not a contraindication to the use of radiotherapy. Radiotherapy has been used in the very distant past to treat acute pancreatitis. If anything radiotherapy will help reduce the inflammation.
What IGRT strategy do you use when treating intact prostate?
We typically do gold fiduicials at our institution for all intact prostate cases and for all fractionation schemes. Only patients we do not do gold fiducials on are those who decline or those who have poor performance status [or otherwise unable to tolerate the gold marker procedure] - in these case...
What is the most appropriate management for a patient with a primary brain sarcoma?
This is a complicated questions, since brain sarcoma covers a wide spectrum. For patients with gliosarcoma or glioblastoma with sarcoma component, they should be treated as GBM. They are eligible for most trials for GBM. Off protocol, they should receive chemo-RT per Stupp regimen. For other sarcoma...
How to you manage radiation brachial plexopathy in head & neck patients?
I am not aware of any effective therapy for brachial plexopathy. Bevacizumab has been reported to be beneficial in radiation-induced brain and retinal injury but I am not aware of its use in neuropathy. In any case, brachial plexopathy after RT of HN cancer is quite rare. I do not recall any BP case...
Is your decision to treat with hypofractionated radiation impacted by histology, ie lobular vs ductal cancers?
Our present approach is to treat all patients (ductal and lobular) and all phenotype with hypofractionation (where we treat breast without RNI) followed by boost. If we feel a patient would benefit from a higher dose we would increase the boost dose but still do hypofractionation for the breast
Do you time initiation of definitive radiation on PSA response to neoadjuvant ADT?
In the setting of definitive RT, I will generally wait 2-3 months before beginning radiation for 2 reasons. First, during that period of time the prostate may shrink by as much as a third of it's original size, which may adversely impact on the normal tissue dosimetry if this were to occur during th...
What treatment technique do you recommend for maximum hearing preservation when treating a vestibular schwannoma: fractionated radiosurgery (25 Gy in 5 fractions) or single fraction radiosurgery?
HI I was asked to respond to this very interesting question, we have tried both 5Gyx5 and SRS for these cases, and we moved our practice from SRS to hypofractionated a number of years ago. I have been equally disappointed with the outcomes in terms of hearing preservation with both approaches, parti...
How does implant breast reconstruction/augmentation at the time of lumpectomy affect your adjuvant radiotherapy approach?
I believe the question may be regarding cosmetic augmentation at the time of lumpectomy, which is not something we see standardly at our institution. I agree that conventional or hypofractionated RT based on the PMRT data would be reasonable in that setting. In patients with breast augmentation prio...
Is there any role for post chemotherapy (R CHOP x 6) radiation therapy after a splenectomy for a stage IE diffuse large B-cell lymphoma involving only the spleen?
Quite an interesting presentation in terms of extranodal site and age. I would say no for consolidative RT here. For Lugano PET CR after R-CHOPx6, the added benefit of ISRT in a young patient is low and counterbalanced by a real long term 2nd malignacy risk. Other than bulky >7.5cm sites, 'special' ...