Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider definitive radiotherapy for IPMN in a patient who is not a surgical candidate?
This is an interesting question, but no I would not. It does seem like a good idea. However, the dose of and impact of definitive radiation in the setting is not defined because there are no published data. In general, treatment of any patient without invasive disease is problematic unless the pre-i...
How long after a tracheostomy would you wait before initiating RT?
If the patient requires a tracheostomy, they are likely a poor candidate for larynx preservation. The next step should be a total laryngectomy and neck dissection likely followed by postop radiation
For borderline resectable pancreas treated with induction chemo therapy and minimal radiographic response, if unable to do SBRT, do you prefer 36/15 or 50.4/28 (given that is where we have more data)?
Low dose small-volume SBRT should not be used in the preoperative setting for pancreatic cancer. It was never a good idea to begin with. Due to very tight margins of 2-5 mm on the GTV, it has resulted in 30-50% marginal miss resulting in local recurrences outside of the treated volume now reported i...
Would you offer the PACIFIC protocol to a patient with stage III lung cancer with performance status 2-3?
The PACIFIC trial did not evaluate this regimen in patients with performance status 2-3. Durvalumab dosing does not change based on toxicity. I do not use this regimen for patients with PS 2-3 without supporting data at this time.
What cumulative dose constraints to you utilize when treating high risk prostate cancer with combined external beam and brachytherapy boost?
With EBRT and LDR we don’t use any specific constraints . we avoid any hot spot at bladder neck and limit prescribed dose to rectum to less than 1 cc . We now routinely use space OAR for boost so rectal dose is usually not a concern.
How would you treat a seminoma recurrence to para-aortic LN one year after a transscrotal surgery?
Theoretically one may need to change the volume to include the inguinal and bilateral pelvic nodes but am not aware of any outcome data which supports that. I would favor ipsilateral pelvis and paraaortic region with boost to node and not include scrotum and avoid exposure of contralateral testis to...
How would you approach an elderly patient with early stage breast cancer with micropapillary histology?
Not a lot of literature but this review (https://www.ncbi.nlm.nih.gov/pubmed/29228910) evaluated invasive micropapillary cancers finding higher rates of LRR.For elderly patients, I would offer hypofractionated whole breast irradiation. Would consider APBI, but would not be my primary recommendation....
What are your dose constraints for treating axillary nodal basin in melanoma with 30Gy/5fx?
The original paper treated with AP-PA fields, and the dose to isocenter was 3-6% lower than the prescription dose. Grade 1, 2, and 3 toxicity (edema) were limited - 21%, 19%, and 1%, respectively. Thus, this remains a standard treatment approach, and our directive is as follows:"27 Gy to cover targe...
Should upfront neck dissection in head and neck squamous cell carcinoma obviate the need for chemo in a T1N2 oropharyngeal cancer with no ECE?
While I do not advocate a neck dissection to avoid chemotherapy, when these patients come to our institution already having a ND performed, if there is no ENE and the primary tumor is small, I think RT alone is reasonable.
Do you routinely offer post-operative radiotherapy for resected retroperitoneal sarcomas?
I do not routinely offer post-operative RT for resected RP sarcomas. Our approach is to offer pre-op. If pre-op is not given, regardless of R0/1 resection, we do not offer post-op. In these case, we will follow with surveillance scans and if recurrence is noted consider pre-op followed by surgical r...