Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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.
What is the best approach to treat a triple-negative inflammatory breast cancer with pCR following preoperative chemotherapy and a prior history of ipsilateral breast irradiation?
Given inflammatory breast cancer recurrence, even with history of previous breast RT, I would offer reirradiation. Given DCIS, nodal irradiation would not have been used and the breast would be removed at mastectomy leaving chest wall. I would give dose of 50 Gy to CW and nodes, and I would use some...
For ultracentral lung cancer abutting the heart, what dose constraints would you use for the heart and bronchus if using 10 fraction ultrahypofractionation?
The dose deviation from Timmerman for the heart is 60 Gy in 10 fractions. Now that they are published, I'd utilize the SUNSET constraints. Patients received 60 Gy/8 fractions (rather than the 10 fraction regimens questioned here) but the best data we have to extrapolate and use constraints that are ...
Have you seen an increase in rectal spasms with short course vs long course radiation for rectal cancer?
The side effect profile is very different with 25/5 RT vs long course CRT. There is no question that 25/5 is “easier” to finish, because the side effects almost invariably start after the last fraction. The acute toxicity of 25/5 is after treatment and, as mentioned above, includes spasm, sensation ...
Do you sample radiologically negative paraaortic nodes in cervical cancer patients with clinically positive pelvic nodes prior to initiating primary chemoradiation?
Possible options in PET-positive pelvic nodes and negative PA nodes: Treat at least the entire common iliac chain, including the aortic bifurcation nodal region, which is 1 level above the affected pelvic nodes. Treat the subrenal PA region prophylactically, especially if the common iliac region or ...
How often do you believe para-aortic radiotherapy in addition to pelvic radiotherapy causes additional treatment breaks due to acute toxicity?
I would agree with @Dr. First Last that with IMRT and accurate definition of targets and organs at risk, that treatment can be delivered successfully. In patients who have had prior chemotherapy, attention to weekly blood counts is imperative. It is usually the platelet counts that pose a challenge....
When would you recommend surgical debulking of pelvic or para-aortic lymph nodes in cervical cancer prior to definitive chemoradiation therapy?
We have not favored dissection and treated with SIB and sometimes added sequential boost ( EQ@ dose 58-66 Gy) based on sizemost current literature shows excellent regional control but high distant failure in these ptsfor bowel and duodenum ( two organs which could be limiting factor) we use v55 dose...
What indications do you use to prophylactically treat para-aortic lymph nodes in cervical cancer?
The answer to this question is not simple although there are some general rules that we use. First, I should mention that for patients with locoregionally advanced disease, we now usually treat to the bifurcation of the aorta as a minimum. This generally puts the upper border close to L3/L4. We bega...
How do you fractionate SBRT for NSCLC abutting the chest wall or in which the PTV encompasses part of the chest wall?
To reduce the incidence of chest wall pain, we typically treat lesions abutting chest wall to 70 Gy in 10 fractions. However, if the lesion is small (<3 cm), 50 Gy in 4 fractions can also be considered if we can meet the chest wall dose volume constraints (30 Gy < 30 CC ideally- if not, 30 Gy < 50 c...
How do the results of LIBRETTO-432 shape the potential role of adjuvant selpercatinib in patients with early-stage RET fusion-positive NSCLC?
The results of LIBRETTO-432 provide strong evidence to consider selpercatinib for patients with stage II-IIIA RET fusion-positive NSCLC, with a highly significant HR of 0.172 (0.058-0.59) for this cohort. When thinking about stage IB (tumors 3- 4 cm, T2b), most of these patients were not included in...