Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat unresectable angiosarcoma of the extremity in a patient who is inoperable due to underlying comorbidities?
Radiation and taxane therapy are both active agents for angiosarcoma. Administering weekly paclitaxel is supported by the ANGIOTAX study (Penel et al., PMID 18809609), and @Dr. First Last and colleagues are conducting a phase II trial evaluating the efficacy of induction chemotherapy followed by pac...
How do you approach decision making in terms to adjuvant chemotherapy after CSI in adult medulloblastoma?
Medulloblastoma is a chemotherapy sensitive disease. The NCCN guidelines have options for CSI alone or followed by chemotherapy for standard risk disease (M0, residual disease <1.5cm2, classic or desmoplastic histology) and recommend post-CSI chemotherapy for high risk disease. Unfortunately, 25% of...
How would you manage a large grade 2 endometrial adenocarcinoma with invasion into the parametria and upper vagina without nodal or metastatic disease?
PETCT and MRI. Preoperative chemo RT with EBRT plus brachy followed by surgery. Vargo et al., PMID 25218303
What dose constraints are appropriate for SBRT treatment to a 5 cm neck metastasis from renal cell carcinoma?
Constraints for thyroid cartilage are not well defined. Trachea/skin one could certainly look up RTOG/NRG, SABR UK consortium, COMET-10 constraints as these are all publically accessible. To me, the most important questions are as follows:1. 5 cm is a large met, are there any other mets? Would the e...
How do you manage anaplastic thyroid cancer that is progressing through radiation therapy?
The algorithms for ATC, a rare disease, have gotten relatively complex including the incorporation and timing of XRT. It is unclear from the question what the presentation scenario is, i.e., localized disease or metastatic, and the mutational status, as ideally at a minimum BRAF status is known. Now...
Do you consider 10MV beams safe in a patient with an implantable cardiac device?
I follow the AAPM TG-203 which considers beams up to 10 MV photons to be non-neutron producing. For example, in a lung, abdominal, or pelvis tumor, I find the reduction in total body dose worthwhile to use 10 MV.
What dose can you give the axilla after 5040 cGy of prior radiation?
I have cases where the patient has previously received axillary RT (45-50 Gy usually) and end up with a recurrence where we would like to re-RT. If they have surgery and have factors such as multiple nodes, ECE, I will re-irradiate to a dose of 45 Gy/1.8 Gy fx. There are data suggesting low rates of...
How do you decide between whole brain radiotherapy vs partial brain irradiation vs SRS for treatment of CNS metastases?
Many factors are at play in choosing WBRT vs. SRS: number, size, and location of the brain metastases – goals of care/patient wishes/comorbidities — pace of the disease, histology, concurrent therapy — to name only the main factors... In the end, it often is usually a subjective recommendation for a...
What dose do you recommend in adjuvant setting following R0 resection of Sinonasal undifferentiated carcinoma (SNUC) involving paranasal sinuses/nasal cavity and close proximity to eyes?
60 Gy to primary site and 50 Gy to neck with protons.
Is it necessary to include entire lymphocele in CTV while treating post operative nodal sites of pelvic malignancy?
I don’t know if necessary or not but I tend to include it if can do it safely. If large and pathological node was negative, then skip to reduce dose to OAR.