Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend scrotal RT in a patient with stage IV primary testicular lymphoma with CNS involvement after CR to RCHOP and MTX?
Irradiation to the contralateral testis is an important component of any successful curative regimen for patients with all stages of disease.In a survey by IELSG (JCO 2003), patients who did not receive contralateral testicular RT had a 43% incidence of testicular failure after CR to anthracycline b...
How do you evaluate PSA decline after EBRT for low-and intermediate risk prostate cancer not treated with ADT?
This is not an answer that comes with any hard data, although both NCCN and AUA offer guidelines on PSA monitoring after therapy. First, I check a PSA at treatment completion. This is not so important when ADT is used, as PSA pretty much universally will decline (at least initially) on ADT. However,...
Would you offer adjuvant radiation to a patient with uterine undifferentiated sarcoma s/p resection, vaginal cuff recurrence, and re-resection?
Following principles of managing sarcoma, I would favor RT with a combination of EBRT and brachy.
Is there evidence for dose escalation of large bony metastases secondary to hepatocellular carcinoma?
Interesting question. The thing with HCC bone mets is that if you use only a nuclear bone scan to contour GTV you miss tumor, according to a paper from Korea (1), because HHC bone mets tend to have large soft tissue components. Further, a Japan report(2) from 1998, looked at successful pain relief o...
Would you recommend chemoradiation to the pelvis for a patient with squamous cell carcinoma of the anus metastatic to the liver who has had a complete response to chemotherapy in the pelvis and a liver resection?
The patient is very fortunate. Oligometastases in anal cancer is not a well-studied phenomenon. I do think that this patient is at risk of recurrence in the pelvis, which could be very symptomatic. For this reason, I would suggest radiation therapy. And probably at doses used in the early days of tr...
When treating locally advanced breast cancer preoperatively that is progressing on neoadjuvant chemotherapy, to what doses do you treat the gross disease, breast, and regional nodes?
I typically treat 50 Gy to large fields including the entire breast and regional nodes and take any gross disease to 60-66 Gy. I also discuss with my medical oncologist the possibility of concurrent xeloda as well.
When treating prone breast how do you recommend contouring the breast?
I typically follow the atlas guidelines but will "cheat" laterally and/or posteriorly in some cases. For example, if the heart would be in the field and the tumor is not posterior, I may not come all the way to the pectoralis posteriorly; or, if treating all the way to the latissimus results in too ...
How would you manage a patient with high risk prostate cancer with rising PSA after RP who has oligometastatic bone disease in the pelvis?
For now, the standard of care is systemic treatment of which the type is sometimes driven by extent of bony disease.
Which radiation modality for definitive prostate cancer has the lowest risk of erectile dysfunction?
This is a great question. Historically, we have considered brachytherapy to be superior, with the caveat that I am not aware of any randomized data to support this. What is interesting is the ProtecT trial showed almost no difference in erectile dysfunction at 6 years between the Radical Radiotherap...
Can post-lumpectomy radiation be omitted for ER/PR(+) low-volume (2 mm) low-int DCIS, with > 2 mm margins in a post-menopausal patient who will be taking tamoxifen?
This is an individualized decision weighing the benefits and potential toxicity. We know from many prospective trials that none of the clinical features mentioned sufficiently put the recurrence risk low enough (often defined as <10%) to omit radiation. However, radiation also likely will not have a...