Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider just treating radiographic residual disease (as opposed to all original sites of disease involvement, per ILROG guidelines) in a patient with bulky early-stage Hodgkin's lymphoma of the mediastinum?
If the patient is treated with > 4 cycles of chemotherapy and the disease is considered chemo-refractory, and if dose constraints to critical structures especially to the lungs can be achieved, I would recommend treating all the original sites of disease involvement, then add boost to the residual s...
When would you recommend postmastectomy radiation to a male, status post mastectomy with 1/1 sentinel nodes with ITCs?
Upfront ITC is not an indication for PMRT unless indicated for T factor. ITC after chemo, would treat like node-positive with PMRT.
When would you recommend radiation therapy for an asymptomatic pathologic fracture in a vertebral body?
I agree with Dr. @Dr. First Last. What you may be describing here is the finding of an incidental bone metastasis in a preexisting osteoporotic fracture, since bones that fracture due to cancer are generally extensively infiltrated by tumor, and in my experience these are often not painless. However...
What is the flank radiation dose for recurrent Wilms?
For children with recurrent Wilms who had NO treatment with either chemo or RT, we recommend the lower doses mentioned in AREN0532 (NCT00352534). All treatment- recurrent Wilms should receive higher doses as stated in NWTS5 (NCT00002611).
Do you block kidney to meet kidney constraint when treating Wilms with diffuse unresectable peritoneal implants?
Yes, either block or use imrt.
What are the indications for RT for an alveolar FOX01 fusion positive, paratesticular rhabdomyosarcoma s/p radical inguinal orchiectomy and PLND showing pN0, group 1, stage 1 disease?
We have not radiated in this specific scenario. While there are still questions about the need and benefit for adjuvant RT in patients with completely resected alveolar histology or FOXO1+ disease, the absence of a clear target in patients with paratesticular primary involvement with complete resect...
How would you treat laryngeal neuroendocrine carcinoma?
It would depend on extent and differentiation. If small cell, chemo RT. No point in surgery because they almost always develop distant metastasizes. If differentiated, it would depend on extent and surgical alternative.
Would you consider lymphovascular invasion at the margin to be a positive margin in breast cancer surgery?
LVI is an independent risk factor for local relapse despite adequate treatment. That being said, we don’t chase LVI to get negative margin as it is non contiguous involvement and not contiguous process which warrants any reexcision.
What brachial plexus dose constraints do you apply when treating conventionally fractionated NSCLC?
Yes. I am presuming you are discussing treating definitively with CRT for locally advanced NSCLC.Since RTOG 0617, most people that treat NSCLC prescribe to a dose of 60-66 Gy in 30-33 fx, as this is a feared toxicity that is very painful and decreases QOL. We try to keep the brachial plexus dose to ...
In what head and neck subsites, if any, would you recommend adjuvant radiation s/p high quality neck dissection if pN1 disease (single ipsilateral LN <3cm) was the only risk factor?
The societal guidelines are all over the place. I will consider PORT in pN1 patients without other pathological risk factors if the primary was oral cavity. Oral cavity primary is, itself, a risk factor for locoregional recurrence (Peters et al., IJROBP 1993). Various retrospective studies have sugg...