Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach thoracic treatment volumes for limited-stage small cell lung cancer?
Usually finding a target in LD-SCLC (limited disease, small cell lung cancer) is not a problem. The early days was very much cookie-cutter including both above clavicle regions, both hila and down to diaphragm. When the Intergoup trial was conceived in the late 80's, there was a need to define volum...
Do you routinely use IMRT to spare the carotids for early-stage glottic cancer?
Not only can IMRT spare the carotids here, and as I recall Dr. Fuller and others at MDACC were one of the first to officially publish some results on this, but it also reduces acute skin toxicity. It should be dosimetrically apparent that if you go from an opposed lateral field arrangement to a 3-fi...
Do you routinely recommend adjuvant radiation for R1 resected paragangliomas?
I think it depends on location but in general I do recommend adjuvant radiation for R1 resected paraganglioma. For some patients, I'm comfortable with surveillance with the understanding that radiotherapy can be offered should there be any evidence of progression.
Would you consider omitting breast radiation in a male with early stage breast cancer who has undergone BCT?
We normally favor complete mastectomy and more so if BRCA2 is positive. This way we can avoid RT.
For elderly patients who cannot tolerate chemotherapy, is radiation alone an option for a stage IA favorable classical Hodgkin lymphoma?
In my experience, it has been extremely unusual that a patient with Hodgkin lymphoma is considered a non-candidate for chemotherapy. But I suspect that in community practice that situation may arise because very infirm patients are not referred to major centers and community oncologists may be a bit...
What criteria do you use when deciding whether to offer radiation for thyroid associated ophthalmopathy?
I can say that over the years, I have treated less than a hand full of these kind of cases. All have had excellent responses to the RT too. (I have not had to re-irradiate any....) In any event, the rule for me is, or, has been, is that if the patients were referred from the Opthalmologist (typicall...
What is the recommended treatment volume for residual or recurrent pituitary adenoma after resection?
I usually do just the gross disease for conventional and SRS.
Can SIB technique be used for GBM treatment?
I have done a lot of SIB when treating GBM. I would deliver 5000 cGy in 25 fractions to the T2 abnormality with a 1 cm margin, while simultaneously giving 60 Gy in the same 25 fractions to the T1C+/cavity region with a 1 cm margin. It cuts off a week of treatment that I think patients appreciate bot...
Would you consider a third course of radiation to the same site for late lung cancer in-field recurrence?
There are several important issues to consider before you even considering treating this patient1. Are you sure it's a recurrence? If PET/CTs are used for follow up, false positives are very common. It is vital to ensure there is nodularity (more likely to be a recurrence). Offering a course of anti...
Are there any cases for which you would limit the dose to the scapula or ribs when treating the breast/chest wall and regional nodes?
Dose to ribs should be limited in cases of reirradiation, where the risks of chronic chest wall discomfort, rib fractures, and bone necrosis are increased. Nonetheless the risks of serious toxicities with reirradiation appear to be low, based on a multicenter retrospective review (Wahl AO, IJROBP 20...