Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider hypofractionated weekly whole breast irradiation for early stage breast cancer?
A word of warning to those who are still "struggling" with the concept of modest, daily HFRT for post-menopausal, biologically-favorable early-stage breast cancer, your mind is about to be blown...FAST! "Once a week??!! Where did this come from??!" is a question I've heard not a few people asking ov...
Do you request lumpectomy cavity markers to be placed at time of surgery to guide planning?
I worked with a surgeon who was hot to trot on using the Biozorb. However, I noted that it did not always fill and contour the cavity appropriately so ultimately, I felt it truly did not help and it is expensive. I prefer the old fashioned 6-8 clips to outline the cavity in 3D. The clips were also v...
Should patients who received pelvic radiation get colonoscopy screenings more often than what is recommended for the general population?
The excess risk of secondary cancer after radiation has been estimated at 0.5% in a 15 year follow-up period. This relatively low incidence would not justify a higher interval of screening colonoscopy after pelvic radiation. As a component of our patient-reported quality of life survey, we do screen...
Would you consider APBI in a patient <50 years of age?
I do consider these patients for partial breast irradiation, discussing with them that there may not be large numbers of patients treated in this cohort however. It is also important to note that these patients are eligible based1) ABS Guidelines- https://www.ncbi.nlm.nih.gov/pubmed/290740882) ASBS ...
How would you manage a primary dural low-grade lymphoma?
Primary dural low grade lymphoma is a rare presentation, usually marginal zone lymphoma, mostly scattered case reports in the literature but one recent series from Memorial Sloan Kettering (de la Fuente et al., PMID 27649904). I would rx similarly for other marginal zone sites. Local rx only, usuall...
What dose constraint do you use for the proximal bronchial tree for when treating NSCLC to 60 Gy/8 fx?
The Canadian LUSTRE trial (which randomizes patients to 48/4 or 60/8 versus 60/15) accepts a dose limit of 64 Gy max, and 60 Gy to 5 cc to the PBT for a 60/8 fractionation schedule. Typically we aim to keep the dose relatively less heterogeneous within the target so as not to draw any significant ho...
Why is it more preferable to perform SLNB after neoadjuvant systemic chemotherapy versus before therapy?
Rationale For clinically negative node, the negative predictive value of SNLN is similar before and after chemo. Chemo type and Indication is now based on phenotype rather than nodal status. Doing SNLN after chemo would increase likelihood of node negative disease and this avoid more treatment to a...
When treating an inoperable patient with squamous cell carcinoma of the thoracic esophagus, do you ever dose escalate beyond 50.4Gy?
Given the results of INT-0123/RTOG9405 failed to demonstrate an improvement in overall survival with dose escalation, I do not treat above 50.4 Gy when giving definitive chemoradiation. There is no other randomized evidence to support doses greater than 50-50.4 Gy at 1.8-2.0 Gy/day.Patients treated ...
Would you consider treating elective cervical nodal volumes for a highly invasive pituitary adenoma with high-risk features?
I think this depends on what is considered high risk. In general I do not routinely cover cervical lymph nodes. I’d take into account the size, functional/secretory status of the tumor, and whether pharmacological/surgical options have been pursued.
What is your preferred palliative regimen for pancreatic cancer with pain related to celiac plexus involvement?
I prefer to use 36Gy in 12 fractions, which can be given AP/PA as long as it is homogeneous. Even though the GI rad onc academic community promotes SBRT techniques for palliation, the use of an SBRT technique in this setting is unnecessary for such low doses. I only use an SBRT technique when I woul...