Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose-fractionation do you use when treating primary NSCLC with oligometastatic disease?
The approach to the lung primary in a patient with a single brain metastasis is dependent in our experience on clearly defining the extent of disease in the chest. Thus, the unusual presentation of a single brain lesion with an isolated primary (i.e.,. no regional nodal or distant disease) in the ch...
Do you forgo adjuvant radiotherapy for men with pT3 prostate cancer who have significant urinary incontinence?
I agree that early salvage may be reasonably effective and thus one might carefully observe patients who are not ideal candidates for adjuvant RT. Both the RADICALS study and the RAVES study will examine this issue (timing of post-op RT further). Here's a recent summary of the RAVES trial: BJU Int....
For intermediate risk prostate cancer do you recommend short-term complete androgen blockade or LHRH agonist alone?
I also like to do the combined androgen ablation with RT to stay consistent with the majority of the randomized studies done. There is a subset analysis of Anthony D'Amico's 206 patient study in which PSA recurrence rates were analyzed according to whether combined androgen blockade was received (as...
In early well-lateralized SCCA of the tongue (pT1-2N0), should the contralateral neck be radiated?
We did a multi institutional analysis of this that was presented at Astro 2018, the manuscript will be out soon. It looked at patients with lateralized oral tongue cancer and showed a 6% contralateral failure rate even in node positive patients. We are comfortable omitting the contralateral neck if ...
In SRS treatment planning, can a dosimetrist take the place of a medical physicist?
Our program has used a physicist and the plan is signed off by a physicist for intracranial cases. For spine SRS cases, we have used dosimetrists, as long as it is overseen by a physicist. I don't believe there are any specific rules that does not allow a dosimetrist to do the planning, as long as i...
How do you manage parathyroid carcinomas with positive microscopic margins?
As parathyroid ca is rare and no reliable data about post-op RT exist, we have to extrapolate from common tumors about which we have data. If this was a sq.c.ca in the low neck, or thyroid ca, we would treat the primary site (positive margins) to 66-70 Gy and neck levels II-IV as well as VI and uppe...
Do you feel that HDR brachytherapy alone is adequate treatment for some intermediate-risk prostate cancer patients?
Based upon a nearly 300 patient retrospective analysis of intermediate-risk prostate cancer patients at GammaWest Cancer Services, the answer appears to be a simple "yes," and for nearly all intermediate-risk patients. We published this in the Journal of Urology in 2012, and did not intend to select...
To what dose do you treat enlarged, but PET negative lymph nodes in laryngeal SCC?
If a node meets criteria for involvement by physical examination (firm, stuck to surrounding structures), or CT (enhancing, loss of fatty hilum, rounded), I give the node (+ 3mm for PTV) 70 Gy in 35 fx. Level II would also be a first-echelon node, raising my suspicion. The remaining level II region ...
Should prophylactic breast radiotherapy still be practiced for patients with prostate cancer taking bicalutamide?
The incidence of gynecomastia is higher with monotherapy bicalutamide 150 mg dose which is not very common in North America where biclutamide 50 mg is given with LHRH analogue. if single agent bicalutamide is planned, then people do practice prophylactic RT.
Is the criteria for RT + PCV for low grade glioma too narrow?
This is an excellent question, which unfortunately does not have a straightforward answer. The first and obvious answer is that 9802 evaluated patients older than 40 or less than 40 only if they had a subtotal resection, and therefore the specific benefit of RT+PCV in those less than 40 with a GTR c...