Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When doing a tumor bed boost following whole breast irradiation, what do you typically use for CTV and PTV margin for photon and electron plans?
The optimal boost volume is unknown. Small differences in the size or placement of the boost seem unlikely to impact the risk of recurrence (1,2). Intrafraction motion of the excision cavity is small (3). My own practice is to give a total expansion of 15 mm around the excision cavity to create the ...
Would you treat a mastectomy scar that went into the high axilla with a radiation boost?
I was taught to always use a scar boost when giving prophylactic chest-wall irradiation. That was based on the observation that local recurrences often appeared adjacent to the mastectomy scar before they developed elsewhere in the chest wall. However, the value of giving this extra dose (like the u...
What would you offer postoperatively for a pt with resected 3 separate HPV+ SCC primaries with pN1 disease with ECE who is cisplatin ineligible?
In view of this patient having ECS and three primaries (including bilateral disease), I would definitely treat postoperatively with chemotherapy in conjunction with radiation therapy. I still favor a platinum-based regimen in view of this patient's neurological toxicity due to previous cisplatin exp...
What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?
The real answer is it depends on the medical oncologist as (s)he typically administers the therapy.It also depends on why cisplatin is contraindicated. Is it an otherwise healthy patient who has renal or hearing issues, or is it an elderly patient with a marginal PS for whom cytotoxics, in general, ...
Would you offer re-irradiation in an adenocarcinoma of the distal esophagus s/p neoadjuvant chemoradiation + Ivor Lewis esophagogastrectomy (ypT3N0) 2 years ago now with TE groove/paraoesophageal LN recurrence with complete response on PET following 8 cycles of FOLFOX?
I generally would offer re-irradiation in this situation. If the lymph node recurrence is completely out of the prior field, it becomes an easier decision and much less technically complex in regard to radiation treatment planning. If out of field, I would treat with 50–50.4 Gy 25–28 fractions with ...
What are your top takeaways from ASCO GI 2026?
GLP1 agonist use is associated with improved outcomes for colorectal cancer in a retrospective United States study. Now we need to incorporate this into randomized trials. I think this also provides more evidence that metabolic syndrome type issues may help explain early-onset colorectal cancers. W...
Would you consider a third course of radiation in a patient with a WHO 3 astrocytoma who has previously received a fractionated course followed by fSRS many years later?
After a long interval such as 10 years, some recovery of normal brain tolerance is believed to occur, although the degree of recovery is not precisely known. Many radiation oncologists assume partial recovery of approximately 50-70% of prior tolerance when estimating reirradiation safety, but this i...
What dose and fractionation do you use for gynecomastia prophylaxis?
As I answered on a previous thread to a question that was similarly posed, philosophically I would prefer electrons (less integral dose/more focused - IMHO) as opposed to photons. In terms of dose, it seem these days less is better with single fraction especially. Hence, the NICE (European) guidelin...
Are there any special radiotherapy considerations for women who have double lumpectomy?
Z11102 looked at multiple ipsilateral breast cancers and lumpectomies. For these cases, I would be fine with hypofractionated WBI. Boost would be based on features of each cancer so if it was otherwise low risk for both, I would omit boost vs. if both were higher risk (< 50, ER-), I would boost both...
When treating node positive anal squamous cell carcinoma, does your lymph node boost include only gross disease with margin or do you boost the entire nodal region?
First of all, I should note that, for purposes of RTOG 0529, there are eight nodal regions: mesorectal, presacral, right and left inguinal, R+L external iliac, and R + L internal iliac. So a patient with a clinically involved right inguinal node would only receive boost treatment on the right. The c...