Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does your adjuvant radiation approach differ for ependymomas with RELA fusion?
Ependymomas (EPN) can occur either in the cord, the posterior fossa (PF), or supratentorially, and are found both in adults and children. At a very high level, the standard management consists of resection followed by radiotherapy. Although various chemotherapy regimens have been used in several set...
How do you dose concurrent chemotherapy with once daily radiation for bladder preservation in urothelial carcinoma?
Two contemporary trials which used daily radiotherapy and concurrent chemotherapy are BC2001 and RTOG 0712 with concurrent chemotherapy schedules as below. Other regimens such as platinum alone have been reported on as well.BC2001: 5FU: 500mg/m²/d d1-5 & d16-20 MMC: 12mg/m² d1 Rationale: The study...
How would you manage T4N0 NSCLC with two separate nodules in different ipsilateral lobes?
If there is no lymph node involvement and the two lesions are amendable by SABR, I would TX definitive with SABR for curative intent. The role of adjuvant TX is debatable, depending on molecular profiling and PD-L1 expression level. If not SABR, hypo-fractionated RT or concurrent chemo/RT could be c...
How do you approach a patient with unfavorable stage II Hodgkin's lymphoma who achieved cCR after 6 cycles of systemic therapy but developed acute pericarditis with non-malignant effusion after 2 fractions of consolidative radiation therapy?
Not an answer but a bump to this question in the hopes that someone with experience will provide some input. I have a left breast cancer patient without cardiac history who is halfway through treatment with signs/symptoms and echo/EKG consistent with pericardial effusion likely secondary to acute pe...
What volumes do you cover when delivering salvage radiation for a contralateral neck recurrence after upfront ipsilateral neck radiation for tonsillar cancer?
Levels 1b, 2, 3, 4, 5, and RP on the previously unirradiated neck.
Would you give whole-abdomen RT for preoperative rupture of favorable histology Wilm's Tumor treated with induction chemotherapy followed by GTR?
The short answer is yes, if you saw free fluid in the pelvis pre-treatment, and there were other signs of pre-operative rupture at the time of resection following chemotherapy, then WART should be considered.Given that the patient had positive LN at diagnosis, I would review the path report to see i...
What is the optimal sequencing of systemic therapy and consolidative thoracic RT for oligometastatic NSCLC?
I personally prefer doing sequential therapy first, for 3-4 months, then reassess for continuing oligometastatic state. This is how it was done in the Gomez randomized phase II study in which a PFS and OS benefit was observed. I think that by doing systemic therapy first some patients who are rapidl...
How do you use higher photon energies in your treatment of breast cancer with tangent fields?
Mixed energy use is very common in large breast to achieve dose homogeneity. In our dosimetric study, mixed energy use was about 65% with the goal to keep V105 low. The contribution from high energy can vary from 10-50%. Chen et al., PMID 29548340
Does anticoagulation alter your decision for elective nodal radiation in a prostate cancer patient?
The short answer is no. I have not seen strong evidence that anticoagulants increase the risk of GI toxicity. However, if bleeding develops, it may be more difficult to manage. The source of bleeding is generally in the anterior rectal wall, as it is with patients not on anticoagulants. Thus, I tend...
Does the presence of a BRCA 1/2 mutation affect your recommendation for post-mastectomy RT in patients with pT1-2, N0 disease?
It doesn’t influence RT decision.