Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When planning a moderately hypofractionationed treatment for prostate cancer, do you recommend using a bladder volume dose constraint?
We aim for 70 Gy < 10 and 35 Gy < 40 - 50 and try to avoid hot spot in bladder trigone region.
Do you consider post-operative radiation therapy for pancreatic neuroendocrine carcinoma?
In collaboration with @Dr. First Last, MD, Northwell Health Radiation Oncology Resident The first and most important point is that there is no clear level I or even prospective evidence to inform the use of radiation therapy for pancreatic neuroendocrine cancers, and it is unlikely that there will b...
Are there any circumstances in which you would recommend adjuvant chemoradiation for resected olfactory neuroblastoma?
Agree with Dr. @Dr. First Last. Our experience treating 29 patients with Kadish B and C neuro esthesioneuroblastoma with local RT if positive margins, and no neck RT when the neck was N0, resulted in 27% neck failure including in the contralateral neck. 5-year LRF rate was 29% in patients who did no...
At what PSA value do you obtain molecular imaging in a post RP patient with previous salvage prostate bed radiotherapy?
The answer to this question will strongly depend on what you intend to do with this information. If you have a patient with a very slowly rising PSA, say a doubling time of years, this patient may not benefit from any treatment so you may want to continue to observe them without any further testing....
Would you consider ultra-hypofractionated 5 fraction regional nodal radiation in a node + breast cancer who otherwise wouldn't tolerate 16 fractions of RT?
At this time, unless there was a strong reason that hypofractionated breast + RNI in 15-16 fractions couldn't be done, I wouldn't use 5 fx breast + RNI off-trial. If compelling reasons, one could consider extrapolating safety of breast RT from FAST/FAST-Forward and axilla from melanoma data.
How would you treat a seminoma if orchiectomy showed a burned out primary with positive pelvic and paraaortic lymph nodes?
If volume of disease is small, would treat with RT and if large, meaning bulky nodes >3 cm or entire chain which seems like the case here, then with chemotherapy CP regimen.
How do you approach treatment of an optic glioma in an adult?
Optic gliomas, particularly the pilocytic variety (generally found in children) are very rare in adults (unless associated with NF1) and the literature is scanty (mostly case reports). The diagnosis is frequently delayed and therefore, significant visual loss is common at diagnosis. The histology is...
How would your elective nodal coverage change in a patient with anal cancer metastatic to a high external iliac node?
I agree with the comments above, but I have an additional comment. For some reason as a field, we have pushed the dose to electively treated regions to 45 Gy, although there are no data in the literature to justify that high a dose. I would extend the radiation fields to the celiac axis but would li...
For a cystic lung tumor <5cm, are there any special SBRT planning considerations that you consider as compared to a solid lung tumor?
I don't typically change much about SBRT planning for cystic lung tumors, besides being particularly cognizant of any interfraction changes on the CBCT. In my experience, I haven't yet noticed major differences in outcomes for these tumors. I am not familiar with literature specifically asking this ...
What is your approach to adjuvant radiation in SCC of oral cavity with exposed bone following mandibulectomy and reconstruction?
Wait up to 8 weeks (prefer 6), irradiate, and deal with bone later if still present.