Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose-fractionation do you use for recurrent SCC (face) that was previously multiply resected and radiated, but has a persistently positive margin after re-resection?
Either 64 Gy at 2 Gy per QD fraction or 64.8 Gy at 1.2 Gy bid. I would electively treat treat the nodes if not previously irradiated. If nodes were previously irradiated, I would not.
For a patient with terminal ileal Crohns disease who requires chemoRT for distal rectal cancer, can mercaptopurine (6MP) be continued during that phase of treatment?
6MP is an antimetabolite that was not developed as a radiosensitizer. So at the right dose it is probably a selective radiosensitizer similar to 5FU. There are no data reported with radiation and 6MP, so this statement is just deductive reasoning. The worst that can happen is an enhancement of acute...
In a patient with distal esophageal cancer with a single non-regional neck lymph node, would you offer chemoradiation therapy or surgery to the primary site if the lymph node has a complete radiographic response after chemotherapy?
If the patient continued to have dysphagia or disease in the esophagus, that would push me to do consolidative chemoradiation. If they are enjoying a good quality of life and no swallowing symptoms and no evidence of disease, I don't believe there is enough data to uniformly recommend chemoradiation...
What small bowel constraint do you use when planning standard/moderately hypofx EBRT for prostate cancer?
For conventional fxn (1.8 Gy) Max dose 52 Gy per RTOG Prostate Consensus Group (PMID:18947938) Personally, use 50 Gy V45 <195 cc per QUANTEC Personally, push lower to <135 cc For moderate hypofxn (2.5 Gy) V40 <1% per Duke constraints (PMID:28244406) To the best of my knowledge, CHHip (60 Gy/...
What dose constraints, if any, do you use for the thyroid gland when treating with regional nodal irradiation for breast cancer?
I have not used any constraints for thyroid for RNI but based on the volume, dose is confined to ipsilateral lobe of thyroid.
How do you approach post operative radiation therapy to someone with head and neck cancer who has high risk of local recurrence who also has scleroderma?
While the risk of morphea (skin and subcutaneous damage ) after radiotherapy to breast ca is well documented, there are very few data about the risk in HNC. Searching Pubmed for: scleroderma, radiotherapy, and head neck, I get only 2 references, one of which is a case report of a severe late toxicit...
Should systemic therapies be added to ADT and salvage RT in patients with PSAs >2 ng/mL after RP?
The question is asking for patients who underwent RP, and the PSA either was persistently elevated to ~2.0 ng/mL, or was observed until it was 2.0 ng/mL, what is the standard of care. The only salvage RT trial that really enrolled men at a PSA of 2 or higher was RTOG 9601 (GETUG-16 allowed up to 2.0...
Would there be any contraindication to whole pelvic RT for a patient with an ax-bifem bypass & the graft crosses the lower abdomen within the RT field?
I am not aware of any contradiction and have treated patients with peripheral bypass
Should radiation therapy be offered to the prostate +/- pelvic nodes in a patient who had PSMA PET/CT positive pelvic LN and prostate disease that resolved after a year of ADT?
Difficult to say but.......PSMA (Prostate specific membrane antigens) PET scans, are undergoing active clinical trials is seemingly the way of the future for imaging in most PCs cases as opposed to the current use for Axumin PET scans which are used for PSA progression only, to date. In this patien...
Would you offer post-operative radiation to a patient with a parotid basal cell adenocarcinoma after a negative margin resection?
Depends on grade. I think they are usually low grade so no. Anything high grade and adenoids cystic carcinoma, yes.