Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider repeat SBRT for a hilar in-field recurrence previously treated with SBRT?
This is a very tricky problem that comes up too frequently. It sounds like the patient may have a central or ultracentral recurrent tumor. Although they fall in similar pots based on most published series, they are very different and the worry factor is different. For this situation, I would define ...
Do you contour and constrain cardiac substructures when treating locally advanced NSCLC with chemoradiation?
In my practice, I have typically contoured the heart and left ventricle. As long as the heart contour is adequately high (I typically stop after the left atrial appendage), the left coronary system is included in the overall heart contour. (See figures 1-3B in Feng et al., PMID 20421148).As far as c...
Is Guillain Barre syndrome a contraindication for radiation therapy?
It depends on what site one is treating as it's causing acute onset neurological deficit in response to viral infection.
Would you treat a locally advanced head and neck cutaneous squamous cell carcinoma with axillary-only mets definitively?
I would consider the possibility of another primary tumor from the extremities or trunk as a possible synchronous source of regional metastasis in the axilla. Isolated "distant" metastasis in the axillary lymphatics from a primary tumor on the head and neck is relatively rare, although admittedly, d...
What bladder-filling protocol do you use when treating children with bladder neck rhabdomyosarcoma with definitive radiotherapy (VMAT)?
We have experiences from Proton beam therapy. Bladder filling protocol will depend on the tumor and age of the patient. Our preferred way is to do it via suprapubic catheter if the tumor is not interfering with the position of the catheter. Filling volumes may be around 150-200 ml (however, the age/...
How would you treat a relatively focal but multinodular staple line recurrence of non-mutated lung adenocarcinoma s/p margin-negative lobectomy?
It depends on how multinodular and how far apart the nodules are. If the total PTV is reasonable and dose constraints can be reasonably reached with SBRT, then I would generally prefer to proceed with SBRT. If SBRT is not feasible, then hypofractionated RT versus conventionally fractionated chemo-RT...
What indications do you use to consider adjuvant radiation therapy for vaginal cancer s/p resection?
If it’s stage 1 disease with negative margin and nodes negative, then observe. If anything more than above, then add EBRT plus brachy.
How do you approach medically inoperable pleural mesothelioma confined to a single hemithorax and symptomatic for chest wall pain, not responsive to first-line systemic therapy?
In these settings, our convention has been to use 20 Gy in 5 fractions. This is based on studies that have shown palliative benefit in mesothelioma with doses at or exceeding 4 Gy per fraction, and also following the phase 2 SYSTEMS trial (MacLeod JTO 2015) using the 20 Gy in 5 fraction regimen. In ...
Is xeroderma pigmentosum a contraindication for adjuvant radiation therapy to the breast in the breast conservation setting?
It’s not a contraindication to RT as DSB caused by ionizing RT is not the same as damage caused by exposure to UV rays.
What fractionation do you use for prostate cancer after TURP?
I would discourage the treatment of low risk prostate cancer in favor of active surveillance, especially in a situation such as this where there may be an increased risk of complications with RT. For intermediate risk, I use 1.8-2 Gy fractions and I may lower the total dose to around 75.6 Gy. For th...