Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
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...