Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your preferred dose-fractionation regimen for cT1-T2N0 oropharynx treated with radiation alone?
The results from RTOG 0022 showed very high local control and low salivary toxicity with moderately accelerated hypofractionation SIB. They gave 2.2 Gy x 30 fractions (66 Gy) to gross disease, and 1.8 Gy (54 Gy) to lower risk areas and achieved <10% LF at 2 years. 7 patients failed, but 2 of them ha...
Would you electively cover any nerves for adenoid cystic carcinoma of the tonsil with positive PNI on pathology?
Absolutely YES. With positive PNI, I don't think it's just "elective", it should probably be a "must". With the capability to do precision-oriented irradiation technique via IMRT/SRT nowadays, I think target volume coverage along a major branch of a relevant cranial nerve is relatively achievable wh...
How do you approach a patient with prostatic urethral lift (UroLift) seeking definitive radiation for prostate cancer?
I've not yet seen a patient with a UroLift device in place. Apparently, from the company website, the device is H-shaped and the vertical parts are on either side of a prostate lobe and connected by a suture-like strand. The vertical parts compress the prostate lobe and are placed on either side of ...
What is your management strategy for unresectable endometrial cancer due to gross cervical involvement with parametrial extension?
Our approach is PETCT and MRI for staging. Neoadjuvant chemo RT with external beam and brachy to EQ2 dose of 65-70 Gy folllowed by extrafascial hysterectomy and then adjuvant chemotherapybelow is link to our published datahttps://www.ncbi.nlm.nih.gov/pubmed/25218303
What methods do you use to decrease genital skin reaction when delivering pelvic radiation to patients in the prone position?
If you are seeing skin reactions in the genitalia in females, you are probably affecting their long term sexual function. Patients discontinue their sexual activity due to pain at the introitus when that area is treated. I don't treat patients in the prone position if genitalia sparing necessary as ...
When would you consider treating a testicular relapse with definitive radiation in a child with ALL?
I would strongly advise against treating with testicular radiotherapy alone at relapse given that testicular relapse is often a harbinger for systemic relapse (depending on the length of first clinical remission) which radiotherapy alone strategies will fail to address (PMID: 8275428). Radiotherapy ...
Would you consider SBRT for a retroperitoneal sarcoma with an R2 resection near critical structures precluding re-resection?
This is a great question. The area of risk in R2 resections are the residual disease and the entire retroperitoneum. Thus, if feasible, the post-op retroperitoneal volume should be treated to 66 Gy (due to the R2 resection) as it is at high risk for recurrence. One could consider boosting the residu...
What dose constraints do you use for pituitary in a young woman with completely resected esthesioneuroblastoma?
As low as possible. Not top priority for me but by default it winds up being around 54 or less.
Is extensive abutment of the duodenum without invasion a contraindication to SBRT for pancreatic tumors?
First, let's be clear that we are talking about a palliative (or neoadjuvant) dose of radiation (53Gy BED). A similar dose, 54Gy in 30 fx, failed to improved overall survival in a randomized phase III trial (LAP07). Next, let's consider one of the most fundamental principles in radiotherapy, fractio...
How do you decide when to electively cover ipsilateral level IB or V in a node positive neck?
The primary site of most concern would be the oropharynx and what to do with level IB if the patient is cN+ and the reason is that sparing the submandibular region may lead to decreased toxicity, as it's function provides baseline moisture in the oral cavity (as opposed to the parotid gland, which i...