Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What imaging schedule do you use for patients with SCLC who choose surveillance over immediate PCI?
In extensive stage patients that undergo surveillance rather than PCI, I've been using the follow up schedule that the Japanese PCI trial (www.ncbi.nlm.nih.gov/pubmed/28343976) used which was q3 month MRI for a year, then q6 month MRI up to year 2.
In the setting of head and neck cancer, if the pathology report shows extranodal extension (ECE), but the location of the node is uncertain, how do you define your boost volume?
It is important to discuss the case with the surgeon and your pathologist to get their input regarding the size and possible location of the node with ECE within the specimen. Ideally, every surgeon that's performing a neck dissection for possible cancer will orient the specimen and divide it into t...
For patients demonstrating ypN1 disease on SLNB following neoadjuvant chemotherapy, is it reasonable to proceed with regional RT in lieu of AxLND outside of the ALLIANCE A011202 trial?
Ideally these patients should go on the Alliance A011202 trial or have a full dissection as the current standard. AMAROS and other studies clearly have shown that radiation to the axilla is highly effective compared to axillary dissection for patients with a positive sentinel node at initial diagnos...
For a MALT of the eyelid, do you treat the entire conjunctiva reflection as well, or just the eyelid?
can you clarify the question? Is the question whether to treat superior and inferior conjunctiva (eyelids) or whether to treat deeper and more laterally on either the sup or inf Eyelid?
Is pectoralis muscle invasion an indication for post-mastectomy radiation (PMRT) for an otherwise early stage, node negative breast cancer with clear margins?
In and of itself no. Given the inclusion of specific node negative patients in MA.20 and EORTC 22922 and small but significant DFS benefit in both, by extrapolation to mastectomy it behooves us to consider carefully the potential benefit of PMRT in node negative patients without over-treating. In re...
For localized esophageal cancer in patients with preexisting neuropathy, what do you use concurrently with radiation therapy?
I would probably start with low-dose carboplatin and paclitaxel as done in the CROSS trial, and monitor carefully for worsening neuropathy with weekly assessment. As the doses are low and the duration of therapy limited to only 5 weeks, we may not see much worsening. In CROSS, there was 15% neurotox...
How would you treat a patient with recurrent brain mets from small cell lung cancer who has already received previous whole brain radiotherapy (30 Gy in 10fx)?
We tend to treat these patients with stereotactic radiosurgery and will treat up to 10 lesions given prior whole brain radiation therapy. We know from studies, however, that despite radiosurgery, they tend to recur elsewhere in the brain and that the need for future SRS salvage is higher than with o...
Do you offer consolidative thoracic radiotherapy to patients with extensive stage SCLC who have a complete response to chemotherapy?
The CREST trial did not meet primary goal of improving one year survival, but it did improve 2 year OS. Looking at subset, achieving CR to chemo was an indicator of a group that "did not benefit". So the rest of the question (what volume, what dose etc) becomes irrelevant.
How long to do you wait after resection of GBM to start radiation?
This is a frequently asked question from patients and there are several large retrospective series examining the timing of adjuvant radiotherapy for glioblastoma. We looked at our own retrospective series https://www.ncbi.nlm.nih.gov/pubmed/26440447 and found that in general, starting radiotherapy w...
How does your approach to contouring change when treating pancreatic body/tail lesions vs head tumors in the postop setting?
For tail lesions, we cover the splenic hilum and for head lesions, we cover the porta.