Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you do neurocognitive testing before giving PCI or any time thereafter?
This is an interesting question and I don't routinely do it, but I think the bigger question is what do you do with that data once you have it. One could argue it both ways and it brings in questions of quality of life and ethics in many ways. Is it better or worse to give PCI to a patient with low ...
Given the superiority of ADT+enzalutamide over ADT alone demonstrated in the ARCHES and PROSPER trials, would you recommend it in the definitive setting for men with high-risk castrate-sensitive prostate cancer?
The quick answer is: No.There is no level 1 evidence that next gen AR-signaling inhibitors (ASI) improve DMFS or OS in high risk localized prostate cancer. Multiple trials are ongoing or maturing in followup, nearly all in combination with RT.Given that most contemporary high risk studies show ~10% ...
Would you recommend surgery +/- adjuvant XRT or definitive XRT in elderly patients with recurrent squamous cell carcinoma of the ear with direct invasion through the cartilage of the helix?
It depends on co-morbidities and functional outcome of surgery. Preferably surgery and postoperative radiotherapy. However, if surgery is not in the cards, radiation alone to 70 Gy in 35 fractions or the equivalent using altered fractionation.
What doses would you treat the primary and lymph nodes in node positive vulvar cancer patient with incidentally found focal SCC in a field of VIN3?
I would treat the primary and inguinal nodes if no additional surgery and SNLN planned. Dose to primary is a function of microscopic or macroscopic disease left behind: 54-56 Gy if microscopic but 60 or above if macroscopic.
What dose constraints would you use for head and neck SBRT in a previously untreated field?
The use of SBRT as a primary modality in patients who have not undergone previous irradiation and are not felt to be candidates for surgery or definitive chemoradiation varies institutionally, with some preferring to treat with hypofractionated regimens (particularly when they are candidates for che...
Would you offer PMRT for cT2N0 triple negative breast cancer s/p NAC and mastectomy with residual disease and no positive lymph nodes?
We need more data. For microscopic residual have not been offering it but if there is residual disease more than 2 cm, we would consider the patient for PMRT.
For cT2N0 bladder cancer receiving definitive chemoRT, do you cover the prostate if you are not treating pelvic nodes?
I generally include the prostatic urethra but I don’t intentionally treat the entire prostate gland. The exception would be a patient who has a concurrent clinically significant cancer which is not very common. By avoiding the posterior prostate you minimize the volume of the rectum that will be inc...
How would you manage a patient with primary CNS lymphoma who is not a candidate for high-dose methotrexate?
This is a relatively rare situation in my experience, but I think WBRT is the second most active agent for PCNSL after high-dose MTX, so if MTX is not possible, I would strongly consider WBRT. Hypothetically, if patient has good PS and you are going for "curative intent", the standard WBRT alone app...
What is your IGRT strategy for prone breast radiation?
We have been using KV/Mv imaging matching both to chest wall and breast tissue like supine position
How do you manage classical early stage Hodgkin lymphoma patients when an ESR is not checked as part of their workup?
I personally don't think ESR plays a huge factor in the management of early stage Hodgkin Lymphoma now in the era of PET-adapted treatment selection. So, if a patient has very favorable stage I-IIA HL meeting all other criteria by the GHSH study and is interested to not have combined modality treatm...