Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer consolidative thoracic radiotherapy to patients with extensive stage SCLC who have a complete response to chemotherapy?
The CREST trial did not meet primary goal of improving one year survival, but it did improve 2 year OS. Looking at subset, achieving CR to chemo was an indicator of a group that "did not benefit". So the rest of the question (what volume, what dose etc) becomes irrelevant.
How long to do you wait after resection of GBM to start radiation?
This is a frequently asked question from patients and there are several large retrospective series examining the timing of adjuvant radiotherapy for glioblastoma. We looked at our own retrospective series https://www.ncbi.nlm.nih.gov/pubmed/26440447 and found that in general, starting radiotherapy w...
How does your approach to contouring change when treating pancreatic body/tail lesions vs head tumors in the postop setting?
For tail lesions, we cover the splenic hilum and for head lesions, we cover the porta.
When should single fraction SBRT be offered for peripheral NSCLC?
Based on the updated results of RTOG 0915 single fraction radiation to 34 Gy in 1 fraction is reasonable to offer to any patient with a peripheral stage I NSCLC < 5cm (limited single institution data from Germany and Japan shows safety and efficacy even for large lesions). While RTOG 0915 does inclu...
How do you manage a patient with gastric/GE junction carcinoma who has positive lymph nodes at resection after neoadjuvant chemotherapy?
So, we know from the review of the MAGIC study by Dr. Smyth that ypN+ tumors are associated with a worse prognosis than ypN0 tumors. However, there doesn't seem to be anything we can clearly do about it with standard options:1) Changing chemotherapy is not likely to be helpful. Phase III studies in ...
What is the maximum acceptable hot spot for hypofractionation breast?
We in our practice follow below guideline V110 of zero percent V105 less than 10 percent (accept up to 15) no V105 in IM fold and nipple areolar region Try to achieve above with FIF, mixed beams and if can't get above then tangential beam IMRT or prone positioning
How are you incorporating abscopal radiation into your practice for metastatic NSCLC?
There is not enough evidence to guide our daily clinical practice about radiation abscopal effect off protocol. However, in stage IV NSCLC, we can use RT to: 1. Eliminate/control chemo or target therapy resistant or persistent primary and oligo-metastases 2. Concurrent SABR with targeted therapy for...
How do you do immobilization for liver SBRT?
There are 2 components of internal organ motion to be concerned with: Inter-fraction motion and intra-fraction motion. Most people have good solutions for respiratory motion control and external immobilization (intra-fraction motion). It's difficult to compare between them because people only know t...
What features would make you consider covering elective nodes in a locally advanced, node negative paranasal sinus SCC?
Yes if >/= T3 or for max sinus involvement.
How do you incorporate NaF bone scan in the initial workup of prostate cancer?
At this point, I think the field is still learning how to make use of these tests and trying to determine which patients are the best candidates. We clearly need better imaging to detect early metastatic disease and lymph node involvement, as these findings would change how we would approach the pat...