Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient treated with peri-operative chemotherapy via the MAGIC regimen for gastric cancer who has a locoregional relapse in unresectable celiac node, how would you approach radiation treatment?
I would give an ablative dose to the node. These nodes are usually not near GI structures. I would electively treat the PA, portal, and splenic artery nodes with a microscopic dose at least down to the level of the IMA. I would not electively treat the remnant in the salvage setting. Dose options d...
What data is there for using SRS to treat more than 3 lesions?
The short answer to this is that there are no randomized trials supporting SRS alone for more than 4 lesions, in comparison to SRS and whole brain radiotherapy, or whole brain radiotherapy alone. This does not mean that SRS alone is contraindicated, and I believe that SRS alone can be used as up fro...
When is it appropriate to use adjuvant whole pelvis radiotherapy for Stage I endometrial adenocarcinoma?
The indications have been changing with the publications of GOG 99, PORTEC 1 and 2 , the Swedish and ASTEC studies, and the interpretation of data with the confounding factor of nodal dissection.At present, I would/do consider pelvic RT for Stage IB with grade 3 disease and Stage Ia with grade 3 and...
In light of the cosmesis and toxicity outcomes of the RAPID trial, should external beam partial breast irradiation be avoided?
The results of RAPID trial does raise the concern about worse cosmetic results which may not have been captured by the CTCAE score used in the NSABP study and one should be very cautious in using this schedule outside the context of a clinical trial. Whether it was because of spillover dose to uninv...
With a head and neck squamous cell of of unknown primary, do you typically treat the larynx?
Not routinely unless the clinical picture really strongly points to the larynx/hypopharynx e.g. p16- and the only nodes or the largest nodes are in level 3-4. It goes without saying that there should be an extensive search process with experienced surgical and radiologic input to try to find the pri...
Is it safe to give localized palliative spinal radiation with concurrent intrathecal cytarabine? If so, do doses need to be adjusted?
In past cases, we have avoided doing this due to concerns of excessive toxicity.
What is the maximum V20 on ipsilateral lung that can be safely accepted for 3 or 4-field breast plans?
We routinely treat the IM nodes so my comments reflect this practice: 1. I shoot for a mean ipsilateral lung V20 below 35%. This is achievable in most, though not all, plans. 2. The biggest driver of ipsilateral lung V20 is the amount of lung in the SCV field. 3. While it is tempting to raise the ma...
Is there any data to support the use of hormone therapy with RT in the adjuvant post-prostatectomy setting?
Unfortunately, randomized data remains limited. Although pT3/N1 pts were included in RTOG 8531 (www.ncbi.nlm.nih.gov/pubmed/15817329), the majority of the pts included in this trial were treated with definitive radiation. At ASTRO 2011, Shipley et al reported the results of RTOG 9601 (www.redjournal...
What is your criteria for a prophylactic PEG tube in patients initiating head and neck radiotherapy?
We do not routinely insert prophylactic tubes to patients receiving bilateral neck RT concurrent with chemo, unless they are malnourished to start with. The outcome is a need to insert feeding tubes to 25-33% of these pts due to sig wt loss during chemo-RT. Thus, most pts do not need PEG. continuing...
What is a safe and efficacious fractionation to use when re-irradiating a recurrent GBM?
One of the approaches for patents not suitable for radiosurgery salvage is 35 Gy in 10 fractions treating only the GTV (as published from Jefferson) showing reasonable palliation even in patients with short interval recurrence after primary treatment.