Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer postoperative radiotherapy to patients with stage I-II small cell lung cancer after complete resection?
In the past, when the RT volume for small cell included the entire mediastinum, it made sense to consider for RT for resected small cell carcinoma. In the era when most people treat involved field even for small cell carcinoma (Dutch data supports this in PET/CT staged patients), the value of adding...
For cutaneous SCC of the cheek with microscopic PNI, which nodal levels, if any, do you prophylactically treat?
Adjuvant radiotherapy for cutaneous squamous cell carcinoma (cSCC) can be a complicated subject because of the limited available data. Perineural invasion (PNI) is a reason to consider adjuvant radiotherapy, because several high-quality clinicopathologic correlative analyses have suggested that pati...
Should N1a breast cancer patients with positive intramammary node metastases but negative axillary sentinel node biopsy receive adjuvant post mastectomy radiation?
My philosophy of PMRT for these patients is similar to what I would do for 1 to 3 positive nodes. I recommend PMRT based on other adverse factors. If they have had BCT and the sentinel node is negative (the presumption is the true sentinel node for these patient is the intramammary node with the nex...
Is local failure following SABR higher then previously thought?
The problem really surrounds the common practice of sloppy reporting of patterns of failure in clinical reports. Local failure is failure within the realm of the original T-stage definitions. For lung cancer, failure within the lobe is a local failure. Too many SABR reports have only included failur...
Would you treat radio-graphically positive pelvic lymph nodes when palliating a patient with metastatic patient prostate cancer and obstructive symptoms?
In general, for palliative purposes, I focus my attention on the symptomatic location primarily, so in this scenario my treatment would be to the prostate +/- seminal vesicles (if involved) only. However, if my palliative target is adjacent to some nearby radiographically involved tissues and expand...
How do you counsel young women who want to become pregnant after breast radiotherapy?
It also depends on whether she is on tamoxifen or not and whether she has had chemotherapy. She has to be off tamoxifen if desires to have a pregnancy. We also counsel them that milk output is usually less in the treated breast and that it is not contraindiacted to breast feed.
Can PMRT be avoided in patients with 1-3 + nodes if they achieve a pCR after neoadjuvant chemotherapy?
This is part of ongoing/completed B51 and practices have a wide variation. In our practice, if it is t1 or t2 primary with non triple negative phenotype breast cancer and pCR, favor observation unless not happy with adequacy of SNLN (less than 3 or pre-chemo node not clipped) or the patient is < 40.
When re-irradiating the spinal cord, what do you use as a guideline for the interval between treatment and the amount of tolerance theoretically "regained"?
Perhaps the most commonly used estimate is that the spinal cord “heals” 25% of the previously delivered dose six months after completing radiation. While this statement didn’t originate with the QUANTEC paper by Kirkpatrick et al. on the subject, it is explicitly stated there, and the paper is a goo...
What is the treatment volume for primary breast lymphoma?
This is a rare presentation for DLBCL. In most instances tumor fairly small and lumpectomy can be performed and usually has been before dx is established. Post chemo I usually rx whole breast to 30gy. One could argue against RT theoretically if lumpectomy with neg margins has been performed but it i...
When do you recommend consolidative XRT for patients with advanced stage (III-IV) DLBCL who achieve CR to chemoimmunotherapy?
The cornerstone of therapy for advanced DLBCL is chemoimmunotherapy (R-CHOP). Efforts to improve upon this with systemic therapy have been largely unsuccessful (dose-dense chemotherapy, maintenance R, more intensive chemotherapy, high-dose chemotherapy and autologous SCT, etc.). There are increasing...