Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What volumes do you cover when delivering salvage radiation for a contralateral neck recurrence after upfront ipsilateral neck radiation for tonsillar cancer?
Levels 1b, 2, 3, 4, 5, and RP on the previously unirradiated neck.
Would you give whole-abdomen RT for preoperative rupture of favorable histology Wilm's Tumor treated with induction chemotherapy followed by GTR?
The short answer is yes, if you saw free fluid in the pelvis pre-treatment, and there were other signs of pre-operative rupture at the time of resection following chemotherapy, then WART should be considered.Given that the patient had positive LN at diagnosis, I would review the path report to see i...
What is the optimal sequencing of systemic therapy and consolidative thoracic RT for oligometastatic NSCLC?
I personally prefer doing sequential therapy first, for 3-4 months, then reassess for continuing oligometastatic state. This is how it was done in the Gomez randomized phase II study in which a PFS and OS benefit was observed. I think that by doing systemic therapy first some patients who are rapidl...
How do you use higher photon energies in your treatment of breast cancer with tangent fields?
Mixed energy use is very common in large breast to achieve dose homogeneity. In our dosimetric study, mixed energy use was about 65% with the goal to keep V105 low. The contribution from high energy can vary from 10-50%. Chen et al., PMID 29548340
Does anticoagulation alter your decision for elective nodal radiation in a prostate cancer patient?
The short answer is no. I have not seen strong evidence that anticoagulants increase the risk of GI toxicity. However, if bleeding develops, it may be more difficult to manage. The source of bleeding is generally in the anterior rectal wall, as it is with patients not on anticoagulants. Thus, I tend...
Does the presence of a BRCA 1/2 mutation affect your recommendation for post-mastectomy RT in patients with pT1-2, N0 disease?
It doesn’t influence RT decision.
How would you treat a metastatic small cell carcinoma of the larynx that is locally progressing on cisplatin/etoposide?
I assume metastatic means distantly metastatic. 30 Gy/10 fx or 20 Gy/5 fx local regional RT if progressing on chemo.
How would you approach an early stage node negative breast cancer s/p BCS with a history of severe chest wall burns?
I would favor APBI to minimize volume treated.
How do you account for previous dose from I-131 when delivering external beam radiation therapy near the thyroid bed?
Since I-131 is selectively taken up by thyroid cancer cells and the range of beta particles emitted is 1-2 mm, there should not be any big concerns of overdosing OARs. https://ehs.stanford.edu/reference/i-131-radionuclide-fact-sheet http://www.docs.csg.ed.ac.uk/Safety/rpu/gn/GN009.pdf.
What plan parameters do you prioritize in 3D conformal breast treatment planning?
My colleagues' approaches are reasonable. However, I would like to point out that there are few data to know what the optimal dose-fractionation, target goals, or normal-tissue constraints really are. (These issues are dealt with at greater length elsewhere - see Recht et al., PMID 30366007.)We bega...