Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you look at or constrain V10 lung dose for your IMRT esophagus patients?
I have a few general comments about dose constraints that applies not just to this question, but to normal tissue constraints generally. The first is to keep in mind that, to a great extent, the various lung constraint parameters are correlated. Therefore, in many situations, it might not matter whi...
In what situations would you offer salvage radiotherapy for relapsed/refractory DLBCL?
There are a number of different clinical scenarios when I would consider RT in patients with relapsed/refractory DLBCL. NCCN guidelines (page BCEL-7 and BCEL-8) list RT as an option in several of these settings.1. Relapsed disease s/p autologous or allogeneic stem cell transplantation - In patients ...
Would you offer the UK FAST Forward regimen to a patient with prior breast augmentation?
With a prior breast augmentation, I would not offer FAST-Forward regimen given the lack of data. I am not aware of data with the regimen and breast augmentation.
In stage II/III node positive patients with driver mutations positive NSCLC who are not surgical candidates and are unlikely to tolerate concurrent chemotherapy and radiation, would you consider radiation alone, TKI alone, or would you ever consider TKI + RT?
I am not aware of any data in this regard. Recently, we treated a 78-year-old female patient with MET exon 14 skipping mutation NSCLC with bilateral mediastinal and bilateral supraclavicular lymph node involvement on radiology scans. We were concerned about her ability to tolerate concurrent chemoth...
What radiation dose and fractionation is appropriate for hairy cell leukemia presenting as an isolated skeletal lesion, where systemic treatment is not recommended?
If the patient is not a candidate for any systemic therapy like cladribine or pentostatin, treatment of the bone lesion to 20-30 Gy with conventional fractionation is a reasonable approach. Some of the older case series would treat lesions up to 60 Gy, but HCL is ultimately a radiosensitive B-cell l...
For head and neck cancers do you ever reduce PTV coverage in the post-op setting to meet an OAR constraint?
There is no real clinical constraint regarding parotid glands doses. The threshold of 26 Gy mean dose was based on forward-planning IMRT in the early 1990s, which could spare the contralateral but not the ipsilateral glands. Once inverse planning was available and partial sparing of the ipsilateral ...
Would you omit a boost in a patient with an indication if a very large (>200cc) post-op seroma obscures the actual tumor bed?
Generally for these patients with seroma > 100 cc, prefer aspiration and settling of seroma before starting RT. Also in general, we tend to rescan for boost most of the time as favor lateral decubitus position and also account for change in size of seroma. Kannan et al., PMID 23006598
Would you consider treating an adult patient with severe claustrophobia with daily anesthesia for 35 fractions if the goal is larynx preservation?
This is an anecdotal case. I did this once for a patient. T3N0 SGL. Anesthesia wanted a trach to secure the patient's airway (was placed prior to starting treatment). General anesthesia for 35 treatments. Trach was removed soon after completing treatment. The patient is now 8 years post-treatment, l...
Would you offer definitive XRT for muscle invasive bladder cancer arising within a bladder diverticulum?
A diverticulum is a common location for bladder cancer to arise. I am not aware of any association between RT diverticula and increased risk of bladder perforation. I have personally never had an issue treating diverticula to full dose (either 64 Gy in 2 Gy fractions or 55 Gy in 20 fractions) in ter...
Will the recent publication of the KROG 08-06 trial change your practice in node positive breast cancer patients?
I would encourage listening to Dr. @Dr. First Last's ASTRO discussion of this trial.KROG 08-06 was powered to detect a 10% DFS advantage for inclusion of the IM chain. Meanwhile, RNI trials have demonstrated a 3-5% advantage in DFS for RNI such that even if irradiation of the IM chain were responsib...