Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the volume and dose for a rhabdo bone met showing complete response to chemo?
On ARST1431, the GTV2 for a bone met in CR should be defined as the residual bone abnormality as seen by CT/MRI at the time of RT planning. SBRT to bony metastases is optional on 1431 and the decision may vary based on patient age and other factors. On the upcoming high risk protocol, where SBRT to ...
What dose do you treat the involved lymph node chain to in definitive radiation for rhabdomyosarcoma?
In our trials, we have used 36 Gy for microscopic nodal disease treatment (either the CTV surrounding gross lymph node involvement or for nodal regions where resection has been performed - e.g. paraaortic LNs in paratesticular primary disease). The extent of this 36Gy treatment volume in the H&N reg...
Can hydrogel, SpaceOAR, placed interstitially for prostate cancer embolize to the lung?
I doubt that this could happen as the Precursor and Accelerator solidify rapidly. Moreover, when injected between the rectum and prostate as indicated, there would not be a clear vascular route for it to reach the lung. However, if the Precursor alone containing undissolved polyethylene glycol (PEG)...
Would you recommend radiation to oligometastatic boney site for an otherwise pure seminoma who had a CR to BEP x4?
I would first suggest getting a biopsy of the bone lesion. It can be difficult to assess response in a bone met. Solitary bone met is extremely rare in germ cell cancers. If there is disease that did not respond to 4xBEP at a metastatic site, this suggests that the patient harbors micometastic dis...
What radiation dose should be used for definitive chemoradiation for an unresectable pancoast tumor?
For Pancoast tumor, brachial plexus damage caused by the progression of tumor is more common than radiotherapy-induced neuropathy. In fact, many patients present with brachial plexus neuropathy before any therapy. Due to significant symptoms caused by local tumor invasion, the chance of distant meta...
What are your volumes for a patient undergoing total neoadjuvant chemotherapy for rectal cancer who has initially bulky disease and is node positive and has a complete response on restaging MRI after neoadjuvant chemotherapy and before chemoradiation?
The most important thing to keep in mind when deciding on treatment volumes in rectal cancer is to remember the reason that we are treating these patients - and that is to get rid of small volume disease near the margins of resection. The primary purpose is not to treat the luminal rectal mass - tha...
When treating definitive bladder cancer, would you ever utilize a bladder boost first, prior to the larger bladder/pelvic field?
The ongoing NRG/SWOG phase III trial S1806 comparing chemoradiation to chemoradiation plus atezolizumab for MIBC does allow patients to receive their boost prior to the large-field phase of radiation therapy. I too have found that patient compliance with bladder filling is easier at the start of rad...
If patient had a significant treatment break during breast/chest wall radiation, would you consider boosting?
There are instances when I have had patients have a significant treatment break. In those cases, I have added a fraction for every 5 fractions they miss. So in the case of 2 weeks, I would add 2 additional fractions and have used this to the whole field.
Is there a role for orchiectomy in a patient with stage IV DLBCL who presents with a testicular mass?
Primary testicular lymphoma, almost always DLBCL, is primarily a disease of older men. The typical presentation is an enlarging testicular mass. Patients are referred to Urology, an orchiectomy performed, and the diagnosis is confirmed. The patient then undergoes a PET-CT for staging. Many patients ...
Why are skin reactions better with hypofx breast RT vs standard fx breast RT?
The breast hypofx trials were designed to be isoequivalent for 1) tumor control, and 2) late effects. Here is an excerpt from the UK START trialists introduction section:Normal and malignant tissues vary in their responses to radiotherapy fraction size, termed fractionation sensitivity. Responses ar...