Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose schedule do you prescribe to the HRCTV when using interstitial technique for treating cervical cancer with HDR brachytherapy?
I follow the American Brachytherapy Society guidelines (Brachytherapy 11 (2012) 47-52) which uses doses of 5Gyx 5 to HR-CTV after 45 GY external beam and 4.5GY x5 fx after dose of 50.4GY extrenal beam radiationOne has to be aware of increased toxicity in this BID fractionationFor Vaginal - I will al...
Should a glioma patient on phenytoin be completely tapered off prior to starting radiation?
Toxic epidermal necrsosis during cranial radiation has been reported, although very rare. In pateints with no such history, I have not seen any similar complication. However, it would be better to taper off the drug if the patient has a history of the skin condition. When a phenytoin induced skin r...
What is the best radiation therapy treatment for vertebral body metastasis with epidural extension adjacent to the spinal cord for radio-resistant tumors (melanoma, renal cell, etc.)?
I assume you are asking about tumor abutting the cord but without neurologic symptoms from compression. Even if there is not compression, there may still be a role for surgery if there is concern about instability of the spine. A commonly used metric is the SINS score (Fourney et al. JCO 2011; 29(22...
Would you utilize SRS/SBRT in a patient with oligometastatic disease from adenocarcinoma of the lung who is unable to receive standard chemotherapy?
Ultimately, any attempt at promoting a durable progression free survival period for patients with metastatic NSCLC, even if oligometastatic, usually would require the ability of the patient to tolerate some systemic therapy. Nearly all of the studies that have incorporated local therapies in the for...
In patients with 3 or more positive sentinel lymph nodes who get a SLNB only, do you advocate for an ALND even if you are planning to treat their regional nodes regardless?
Although they were underrepresented in AMAROS study, in reality a scenerio like this is so uncommon that it would be hard to have any prospective study. We do not push for dissection if pre surgery imaging and clinical exam was consistent with NO disease and plan these patients with comprehensive no...
Do you preferentially use 10MV over 6MV in CNS IMRT treatments to prevent alopecia?
This seems like wishful thinking. I would be very surprised if there were any clinical data in this regard. Alopecia will be far more related to other factors such as nearness of the target volume to the skin surface and, with IMRT and other treatments that use multiple angled beams, the "obliquity ...
What is your preferred approach to a patient with newly diagnosed primary mediastinal B-cell lymphoma in the upfront setting?
I recommend DA-R-EPOCH in almost all patients. For the rare patients with stage 3-4 disease, I consider RCHOPx4 followed by ICE (unpublished data from Memorial Sloan Kettering).
When treating patients with whole breast RT with a sequential boost, what technique to you use for the boost when treating patients prone for whole breast irradiation?
At NYU, we treat the vast majority of our patients in the prone position and use a number of techniques for the boost. We most commonly treat with mini-tangents in the prone position. We'll often use a combination of 6 and 16MV to help spare the breast lateral or medial to the involved tumor bed. We...
When treating patients with hypofractionated radiation to the breast in 16 fractions do you typically treat 4 or 5 days a week?
We treat 5 days a week which was the standard in the Whelan randomized trial that compared this fractionation scheme to conventional fractionation (https://www.ncbi.nlm.nih.gov/pubmed/20147717). In the START B trial, 15 fractions (total dose 40 Gy) were given also in 5 consecutive days (https://www....
Would you offer prostate radiotherapy to a patient with lymphocytic colitis which is being managed with budesonide?
In general, I look for reasons to avoid irradiating the colorectum in patients with chronic inflammatory conditions affecting this organ. These are patients for whom I generally recommend surgery for prostate cancer. If they end up needing adjuvant or salvage radiation, the dose and volume of irradi...