Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your preferred technique and dose/fractionation for treatment of a metastasis involving the retina or optic nerve?
This is a tough question, because the details are important. Is this oligometastasis? What's the histology (I'd try to give higher doses for melanoma or renal cell carcinoma and may give less for myeloma). What's the location (the further anterior on the globe the radiation the more difficult the to...
What dose constraints would you use for the heart/pericardium when treating a sternal metastasis with five-fraction SBRT?
With the caveat that I would only treat a bone metastasis with SBRT in the setting of oligometastatic disease, I would use the constraints put forward by RTOG in the lung SBRT trials, which is a max dose of 105% (assuming 50Gy in 5) and get lower if possible, especially since there is low likelihood...
How would you approach multiply recurrent prostate cancer in a patient who has had both LDR and salvage HDR?
Very carefully! The risk of GU and GI toxicity from any salvage therapy after both LDR and salvage HDR is very high. If there is a focal lesion identified on MR/PSMA that is distant from the bladder, urethra, and rectum, then maybe you can try a focal treatment. I'd be very careful because the risk ...
Would you consider repeat SBRT for a hilar in-field recurrence previously treated with SBRT?
This is a very tricky problem that comes up too frequently. It sounds like the patient may have a central or ultracentral recurrent tumor. Although they fall in similar pots based on most published series, they are very different and the worry factor is different. For this situation, I would define ...
Do you contour and constrain cardiac substructures when treating locally advanced NSCLC with chemoradiation?
In my practice, I have typically contoured the heart and left ventricle. As long as the heart contour is adequately high (I typically stop after the left atrial appendage), the left coronary system is included in the overall heart contour. (See figures 1-3B in Feng et al., PMID 20421148).As far as c...
Is Guillain Barre syndrome a contraindication for radiation therapy?
It depends on what site one is treating as it's causing acute onset neurological deficit in response to viral infection.
Would you treat a locally advanced head and neck cutaneous squamous cell carcinoma with axillary-only mets definitively?
I would consider the possibility of another primary tumor from the extremities or trunk as a possible synchronous source of regional metastasis in the axilla. Isolated "distant" metastasis in the axillary lymphatics from a primary tumor on the head and neck is relatively rare, although admittedly, d...
What bladder-filling protocol do you use when treating children with bladder neck rhabdomyosarcoma with definitive radiotherapy (VMAT)?
We have experiences from Proton beam therapy. Bladder filling protocol will depend on the tumor and age of the patient. Our preferred way is to do it via suprapubic catheter if the tumor is not interfering with the position of the catheter. Filling volumes may be around 150-200 ml (however, the age/...
Is 2 Gy x 2 (or the "boom boom" regimen) appropriate for treating patients with low volume stage I MALT lymphoma?
I disagree. My answer is no. The quoted series contains very few patients with short follow-up. I am not aware of any large series with long follow-up of MALT pts with early stage disease treated with curative intent in this fashion. A randomized trial of 2gy x 2 for early-stage follicular lymphoma ...
How would you treat a relatively focal but multinodular staple line recurrence of non-mutated lung adenocarcinoma s/p margin-negative lobectomy?
It depends on how multinodular and how far apart the nodules are. If the total PTV is reasonable and dose constraints can be reasonably reached with SBRT, then I would generally prefer to proceed with SBRT. If SBRT is not feasible, then hypofractionated RT versus conventionally fractionated chemo-RT...