Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there any role for differential cardiac substructure dose tolerances when treating with radiation for breast cancer?
There is growing literature on the role of defining cardiac substructures and potential dosimetric constraints for these substructures as an improved methodology for cardiac DVH assessment, as compared to mean heart dose (Jacob et al., PMID 30732640).However, at this time, we do not have robust long...
In the treatment of recurrent trigeminal neuralgia, what local therapy would you recommend after failure of medical therapy?
I will recommend surgery (microvascular decompression) only when there is a surgically fixable abnormality, such as vascular compression. In that case, microvascular decompression is more effective than SRS. Otherwise, I will offer SRS, which can be offered twice targeting a root entry zone and a mo...
Would you offer radiation alone to localized recurrence of extensive stage small cell lung cancer while on maintenance immunotherapy or would you start alternative systemic therapy?
The role of local therapy for the treatment of patients with ES SCLC has been evaluated in a number of phase 3 trials. The first trial, which was published by Jeremic et al., PMID 10561263 over 20 years ago, reported a survival advantage for adding thoracic radiation to chemotherapy compared with ch...
What small bowel dose constraints do you use when treating with short course radiation for rectal cancer?
In my experience, I have set a small bowel max of 25 Gy; sometimes allowing up to 27 Gy. This was out of an abundance of caution; our initial experience (1) was with 20 Gy/5 fractions and there was concern about increasing the radiation dose to 25 Gy. Also, we wanted to make sure that patients with ...
What do you tell men with low but detectable PSA who have completed ADT and RT?
Several analysis have shown that patients who do not achieve undetectable PSA levels after 6 months of ADT have worse outcomes. This is a bit of a moving target and the definition of undetectable has changed over the decades. An important question is - are these patients failing due to incomplete lo...
What is the role of radiation in a patient with stage IV DLBCL with bilateral testicular involvement?
I tend to loosely recommend consolidation RT to the testicles in this situation if in CR. This recommendation is based on pattern-of-failure studies in primary testicular lymphoma where prophylactic contralateral testes RT is usually recommended, and the principle that the testicles are a sanctuary ...
How would you approach the treatment of a low grade adnexal carcinoma of the scalp in a patient with prior history of WBRT as a child?
Post-op RT and RT alone for the second one, if surgery is not an option. No hypofractionation.
How would you manage the cavity of a resected anaplastic meningioma with pulmonary metastases?
Metastatic meningioma outside the CNS is rare, and its incidence has been estimated to be 0.1% with the lung being the most common site for distant metastases (Surov et al., PMID 23404622). There is no clear standard therapy for the management of metastatic meningioma. Suppose this was an anaplastic...
Is radiation therapy a treatment option for refractory Paget's disease of the vulva extending onto skin of buttocks and anal margin?
I have treated localized peri-anal Paget's Disease with good outcomes, and there is some data to support this. I have not treated a patient with such widespread vulvar Paget's and I suspect that the morbidity would be significant given the doses required, and the volume to be treated in the case you...
How would you manage RT for a locally advanced squamous cell carcinoma of the anal canal in a >90-year old if chemotherapy is not recommended?
For any elderly patient, a discussion of goals of care in the context of symptoms is warranted. In the chance this is a small asymptomatic cancer in a patient with limited life expectancy, no therapy may be reasonable. However, this does not seem to be the case for your patient.If the patient is dee...