Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there data to support treating postoperative endometrial pelvic EBRT with a daily dilator in the vaginal canal?
Data is more for GI malignancies on using a vaginal dilator to reduce dose to the anterior vaginal wall and thus the risk of stenosis. With the vagina being a target for endometrial cancer, there is no study using it during RT to show any benefit.Arzola et al., PMID 37898354
What are some considerations for planning T&O brachytherapy in a patient with bilateral hip replacements, where it is difficult to delineate disease on MRI and even surrounding structures on CT?
I have favored MRI-based contouring and planning in these patients. Dual-energy CT or simulation metal artifact reduction software can also help with better delineation and planning.
What would be your radiation boost technique and dose levels for adjuvant treatment of endometrial cancer with high-grade disease or aggressive histology if there was a positive margin at the parametrium after TAH+BSO?
I usually consider 50.4 Gy with EBRT followed by an additional 5.4 Gy to the parametrial region. Whether this additional boost helps is not known.
How do you treat non-spine bone oligometastases?
Get the MRI. It is proven to reduce inter-observer variability in contouring (Raman et al., PMID 29748100). More philosophically, sometimes you'll see something more, sometimes you won't. But the only way to know is to check. And if this treatment is worth doing, it's worth doing accurately -- espe...
When discussing definitive prostate radiation, how do you respond to patients who mention that they heard that surgery is more difficult after radiation treatment?
I love this question! I hear it quite often, and it provides an opportunity to discuss the differences between radiation and prostatectomy, and the potential benefits and risks of both. I start by stating that it is absolutely true that radiation causes scar tissue that can make surgery months to y...
In pediatric patients with Hodgkin lymphoma who have a partial response after chemotherapy and multiple disease sites above and below the diaphragm, how do you approach radiotherapy planning considering cumulative dose and toxicity?
RT dose and target volume in pediatric Hodgkin lymphoma are determined according to the systemic therapy protocol being used. For example, your case suggests a patient with Stage III or IV disease. In the COG study AHOD1331, patients received either Bv-AVE-PC or ABVE-PC systemic therapy x 5 cycles a...
What areas do you treat with RT for an intermediate or high risk pediatric Hodgkin Lymphoma with a slow early response?
For pediatric Hodgkin lymphoma, radiation fields are really based according to the treatment protocol. If the patient was being treated per AHOD 0031, then the radiation fields would include all sites of initial involvement, assuming they don't meet the criteria for omission of RT (RER and then a CR...
Does micropapillary subtype for a G1-2 DCIS affect your radiation treatment recommendations?
It doesn’t change the recommendation. If adequate, imaging and surgery are done, like any other DCIS.
Do you use liver SBRT to areas previously treated with Y90 and subsequently failed?
Prior Y90 is a risk factor for liver decompensation that's hard to quantify. If there is relatively low volume disease and I am retreating with complete overlap of the prior TARE, I don't think there isn't any increased risk with retreatment. If the TARE went to more than 1-2 segments, I would be co...
Does the presence of perineural invasion on a prostate biopsy change your management decision?
I would consider perineural invasion as one of the "soft" criteria that may help impact treatment decisions. Previously this would have also included such things as Gleason 3+4 vs. 4+3, Gleason 8 vs. 9-10, or the percentage of positive cores. However, as these factors have now been included in the A...