Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you use brachytherapy for treating primary tumors of the lip with definitive radiation?
I think the question for most of us is, would you use brachytherapy for treating primary tumors of the lip with definitive radiation therapy? The answer should be yes. I have done brachytherapy in many areas of the body and this is one of the easiest. These tumors tend to be small so this usually re...
How does the risk of urinary obstruction differ between HDR and LDR brachytherapy for prostate cancer?
I think it is important to clarify and distinguish between urinary retention and urinary obstructive symptoms for this clinical scenario. In general, the likelihood of urinary retention requiring catheter placement after the brachytherapy procedure is less than 5% with either high-dose rate brachyth...
Should we continue to offer consolidative radiation for early stage, non-bulky Hodgkin's disease for individuals who have had a complete response (Deauville 1 or 2) after chemotherapy by PET?
The RAPID study was a non-inferiority trial. This requires a small editorial. Non-inferiority trials are designed to test that one approach is "not worse" than an accepted standard. However, in essence you are testing that one approach is "not unacceptably worse" than an accepted standard, because t...
For patients with widespread bony metastases from prostate cancer, do you ever consider treating with beta-emitters such as Samarium-153 or Strontium-89 over Radium-223?
I use radium 223 in all patients unless thier performance staus is poor ECOG-2 or they have significant visceral disease. In those cases it may difficult to get authorization for Radium 223. In terms Cost effectiveness there is data now from the ALSYMPCA trial updates that patient's who received Rad...
Are your criteria for PMRT in men different than your criteria for PMRT in women?
Our indications and need is based on data from treating women with breast cancer and thus follow similar indications. Although because of lack of breast tissues and screening men are more likley to present with advance disease especially extending to dermis and thus moe likely need PMRT
Do you treat elective cervical lymph nodes for SNUC (sinonasal undifferentiated carcinoma) of the ethmoid sinus?
I would always cover bilateral levels II-IV, and also ipsilateral IB if there is nasal cavity involvement. If clinically node negative, high level IIB can be omitted.
Is there an advantage in treating with a SIB (simultaneous integrated boost) over sequential boost for anal cancer?
Radiation therapy, in almost everything we do, is a trade-off betweeen tumor control and toxicity. This gives us the opportunity to change dose and fractionation to obtain what we perceive as the "correct" balance between aggressiveness for tumor control and being conservative to preserve function a...
How would you design PORT volumes for a patient with NSCLC and positive chest wall margin?
A positive surgical margin (bronchial, vascular, parenchymal) after a typical lobectomy/pneumonectomy for NSCLC is rare (~1-2%- JTO 2015;10:1625), a bit higher after sublobar resection, and even higher after chest wall resection (14% in our series- Tandberg et al. Clin Lung Cancer 2016). The most ac...
Do you offer TTF for patients with newly diagnosed GBM?
I would describe it as unethical to not discuss TTF as an adjuvant therapy in the majority of patients with a GBM. The size effect in the randomized trial was twice that of temozolamide and we all agree on strongly recommending in general. The benefit was an overall survival benefit and the practi...
For postoperative gastric patients status post total gastrectomy, how do you approach anastamotic coverage?
In the Gunderson re-op studies, local regional recurrences occurred in 38% of patients when assessed clinically, 67% when assessed by re-operation and 80-90% at autopsy. Of the local recurrences, 25% occurred at the anastomosis or duodenal stump when assessed clinically or by reoperation, and 50-60%...