Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What fractionation do you use for consolidative chest RT in extensive stage SCLC?
3 Gy x 10 is arguably the standard of care.For patients with good performance status, and who do not have extensive disease outside of the thorax (which is clearly a judgment call), we consider 2.5 Gy x 20 with a 2 week break. This is a well-tolerated schedule with respect to esophagitis. For those ...
When treating two primary early stage lung cancers with SBRT, do you treat both at the same time or stage your treatment?
A completely non-clinical but nevertheless "real world" thought:If you deal with Evicore, the insurance pre-auth gatekeepers for many private insurances in the U.S. (BCBS e.g.), and they "catch wind" that you're not going to treat such a patient's lesions synchronously, it's highly likely they will ...
How does the finding of incidental proximal seminal vesicle invasion on mpMRI alter your recommendation for brachytherapy in a patient with prostate cancer who was initially a candidate?
An additional thought........... Regarding this question as well we need to be cautious about the word "incidental". Normally an "incidental" finding would be characterized as a patient who was undergoing a CT scan of the abdomen and pelvis for the workup of a high grade prostate cancer, for instanc...
What is the appropriate dose and volume for adjuvant treatment of a sigmoid colon adenocarcinoma adherent to the L5 vertebral body with a positive radial margin?
There is no firm data on this topic, but in general colon cancers are not that radiosensitive and for positive margins, with no other evidence of tumor, one should go to a high dose. Ideally, if you know from preoperative scans that the margin is likely to be close or positive I would recommend a pr...
How would you utilize adjuvant radiation therapy in a patient with a cutaneous spindle cell neoplasm of the scalp metastatic to the parotid gland?
A lot will depend upon how “total” the parotidectomy really was. If the deep lobe was resected and the facial nerve sacrificed with totally negative margins I would be content to utilize careful observation with no postoperative radiation therapy to the parotid bed. If only a superficial parotidecto...
Do you offer consolidative RT for patients with oligometastatic NSCLC who initially presented with a malignant pleural effusion?
You cited a very important trial. When its results were published I thought they were a real sockdolager to any continued wholesale radiotherapeutic nihilism towards asymptomatic M1 NSCLC patients. (I must admit, in training during years 1999-2003 I can't remember anyone using the word "oligometasta...
How do you manage recurrent CNS ependymoma?
Data for treating recurrent ependymoma comes mostly from single institutions retrospective series. Patients with recurrent ependymoma should be restaged with spine MRI and LP cytology, evaluated for maximal safe resection, re-irradiation, and clinical trials. If the disease is localized, many radiat...
Is it appropriate to use a hypofractionated schedule of 40 Gy in 15 Fx for LS-SCLC?
The study from Norway used 42 Gy in 3 weeks. CONVERT had gr 3 or 4 esophagitis in 18% regardless of QD66 or BID45/3wk. Since I am stuck on 45Gy, I use 45 Gy in 3 wks for incapable, refuse BID or ED-SCLC.
What is the role of radiation in regionally recurrent gastric cancer?
I would treat this like a D2 dissection case that did not receive preoperative chemotherapy. I would treat a large microscopic volume including the tumor bed, gastric remnant and the celiac axis, porta, and splenic nodes. IMRT to 45Gy would probably be necessary in my mind in this case. I would use ...
What factors do you use to determine whether an enlarging lesion after SRS is radionecrosis versus progression?
This is a challenging issue, especially in a community setting where patients had not been treated with SRS before, and radiologists are now confronted with post SRS scans. The two major things that clinicians can look at are:1) T2 - T1 mismatch - if there is a correspondence between the contrast-en...