Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you contour the abdominal para-aortic nodes in your elective CTVnodes for T3N1 adenocarcinoma of the GEJ getting preop chemoRT?
A related question was also asked: Do you include subcarinal, AP window, and mediastinal paraaortic nodes in your CTV for esophageal cancer? Although I am very respectful of the time and effort that goes into writing treatment guidelines, and I frequently consult them in my own practice, it is worth...
Do you include subcarinal, AP window, and mediastinal paraaortic nodes in your CTV for esophageal cancer?
Unfortunately, this is essentially a data free zone. There are certainly no clinical trials to answer the question - it is hard enough to prove the value of radiation therapy without going into second order effects such as on the exact size of the RT field. I personally do not extend the fields prox...
How would you manage a patient with Stage IVB DLBCL with refractory disease in the retroperitoneum and spleen after 6 cycles of RCHOP?
The management of primary refractory stage IV DLBCL is complex and generally not successful. See NCCN Guidelines for details. I would distinguish, however, between those patients who are clinically refractory and those who have clinically responded well but may have residual disease by imaging, i.e....
Do you recommend elective nodal irradiation when treating unresectable pancreatic adenocarcinoma?
Yes. For consolidative radiotherapy following chemotherapy, we have been treating the majority of our patients with SBRT. Off trial, we treat the GTV and tumor vessel interface to 40 Gy/5 fractions via simultaneous integrated boost. The elective nodal volume (pancreatic, porta hepatis, para-aortic -...
Would you consider just treating radiographic residual disease (as opposed to all original sites of disease involvement, per ILROG guidelines) in a patient with bulky early-stage Hodgkin's lymphoma of the mediastinum?
If the patient is treated with > 4 cycles of chemotherapy and the disease is considered chemo-refractory, and if dose constraints to critical structures especially to the lungs can be achieved, I would recommend treating all the original sites of disease involvement, then add boost to the residual s...
When would you recommend postmastectomy radiation to a male, status post mastectomy with 1/1 sentinel nodes with ITCs?
Upfront ITC is not an indication for PMRT unless indicated for T factor. ITC after chemo, would treat like node-positive with PMRT.
When would you recommend radiation therapy for an asymptomatic pathologic fracture in a vertebral body?
I agree with Dr. @Dr. First Last. What you may be describing here is the finding of an incidental bone metastasis in a preexisting osteoporotic fracture, since bones that fracture due to cancer are generally extensively infiltrated by tumor, and in my experience these are often not painless. However...
What is the flank radiation dose for recurrent Wilms?
For children with recurrent Wilms who had NO treatment with either chemo or RT, we recommend the lower doses mentioned in AREN0532 (NCT00352534). All treatment- recurrent Wilms should receive higher doses as stated in NWTS5 (NCT00002611).
Do you block kidney to meet kidney constraint when treating Wilms with diffuse unresectable peritoneal implants?
Yes, either block or use imrt.
What are the indications for RT for an alveolar FOX01 fusion positive, paratesticular rhabdomyosarcoma s/p radical inguinal orchiectomy and PLND showing pN0, group 1, stage 1 disease?
We have not radiated in this specific scenario. While there are still questions about the need and benefit for adjuvant RT in patients with completely resected alveolar histology or FOXO1+ disease, the absence of a clear target in patients with paratesticular primary involvement with complete resect...