Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the appropriate radiation volume for a stage III, group III unresectable embryonal rhabdomyosarcoma originating from the bladder?
For bladder/prostate or pelvic tumors that displaced a significant amount of bowel which has then returned to its normal anatomic position after chemotherapy, GTV1 and CTV1 will be defined by the prechemotherapy extent of tumor excluding the component that is now normal intra-abdominal components (i...
What is the utility and optimal timing of histologic conformation of NGGCT?
This is a difficult topic and a great question. Unfortunately, the thresholds for tumor marker cut-off values vary internationally for germinoma and NGGCT. The Japanese, who do more aggressive surgeries and have a wealth of experience, use higher cutoff values for germinoma, however, they typically ...
What is the anterior expansion for the paraaortic CTV in endometrial and cerivcal cancer?
Usually, around 5mm with editing based on the patient's anatomy and fixed organs like the duodenum. Kabolizadeh, Fulay and Beriwal - PMID 23849691
How would you counsel a patient with extragenital lichens sclerosis on the acute and long term risks of post-lumpectomy radiotherapy?
Lichen sclerosis (LS) is a rare entity, however, there are reports of successful treatment with radiation for various cancers associated with this condition. (Wang et al., PMID 33356763). There is also a suggestion of worse LC in women with vulvar cancer and preexisting LS (Fokdal et al., PMID 34392...
What is your simulation setup when treating bladder with concurrent chemoradiation?
For the majority of our MIBC patients, we do the planning CT in the supine position with arms on the chest. In select cases with concern for small bowel dose, we will simulate in the prone position if safe and comfortable for the patient. If patients are willing and able, we typically recommend a bo...
Is there a role for radiation in a patient with supraclavicular and cervical node recurrence of breast cancer after prior whole breast RT (no ENI)?
If there is no other site of metastatic disease and the above nodes are bx proven, then I would treat this like a regional node recurrence and treat the ipsilateral axilla, s/c, and neck with IMRT/IGRT with dose to the involved nodes to about 60-66 Gy.
What is the longest treatment break you would accept when treating a patient for breast cancer?
There are no data on how a treatment break of months affects outcomes. Her prior treatment likely does not significantly reduce the risk of relapse but probably increases the risk of complications from giving her full-dose treatment. Therefore, I would not irradiate her now, since most patients trea...
Would you treat with post-mastectomy radiotherapy in patients with early-stage (T1-T2), node-negative, hormone-positive disease if the only risk factor for recurrence was a focally positive anterior margin?
Not routinely if only focal unless has a multitude of factors like LVSI, high grade and t2 disease (would also consider if high oncotype score).
How would you incorporate whole abdomen radiation therapy after cytoreduction in an AYA patient with desmoplastic small round cell tumor?
We had one patient with DSRCT. Our group used IMRT for the abdominal radiotherapy while sparing much of the kidneys. The details are in a paper by Pinnix et el, Int J Rad Onc Bio Phys 83(1): 317-26, 2012. (Epub November 2011).
What is your preferred dose and fractionation for verrucous carcinoma of the larynx?
Same as SCC which depends on stage. T1-T2a. 63 Gy/28. T2b. 65.25 Gy/29.