Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
For gross supraclavicular disease in lung cancer, do you cover full dose to the involved lymph node with margin or to the entire supraclavicular fossa?
Sometimes the supraclav area has smaller nodes, that are difficult to palpate. As such, I treat the entire sc fossa...cost is little and recurrence is very difficult to treat. Dose fall off with a margin on a single palpable node may cause a local failure.
When using EBRT to deliver APBI, what dose do you prescribe and to what volume?
3DCRT APBI now has greater data supporting potential toxicity based on results of institutional series, prospective (RTOG), and now randomized data (late toxicity with RAPID). Whether this is related to technique, volumes, or fractionation (3.85 BID) is unclear.For patients at our institution, we us...
What dose and fractionation do you use for definitive radiation for SCC in situ of glottic larynx?
63 Gy/28 fractions larynx only; 93% local control
How do you manage imaging artifacts from surgical staples when planning post-operative radiotherapy for resected brain tumors?
In general, patients I see have their staples removed by the time they come for simulation. That being said, I don't routinely insist they be removed if still intact. I would discuss with my surgeon if there is an indication to keep them longer. If no indication, sometimes I'll just have them stop b...
Is there any data comparing neoadjuvant pancreatic SBRT vs standard fractionation in terms of its ability to convert unresectable tumors to resectable tumors?
Essentially zero%... this patient should be referred to a center that is giving ablative doses. (100Gy BED) or a surgeon that will do a celiac axis resection (Appelby). Alternatively, you should be honest and say low dose SBRT and 50.4Gy /28# have very little to offer him. The LAP-07 trial clearly s...
How long after pancreatic SBRT do you wait to re-image?
Standard imaging interval after preoperative long course radiation has been 5 weeks, by that analogy after a 1 week course of radiation it should be longer but it's an arbitrary decision. The only thing I would avoid is operating in less than 5 weeks because the acute reactions need to resolve. In t...
What rate of second malignancies do you quote for patients receiving radiosurgery for benign CNS tumors?
<1% at 10 years based on following Lancet Oncology paper: https://www.ncbi.nlm.nih.gov/pubmed/30473468
Would you consider PMRT in a patient with N0(i+) luminal A disease?
ITC upfront at this point would not sway decision for PMRT unless it is ITC after neoadjuvant systemic therapy
What dose-fractionation would you utilize to treat a multiply recurrent high-grade urothelial carcinoma of the bladder in a patient who is not a surgical nor chemotherapy candidate?
55 Gy in 20 fractions over a 4-week period like MRC