Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What role does external beam radiotherapy play in the treatment of well differentiated papillary thyroid cancer when a total thyroidectomy and lymph node dissection cannot be performed?
Following a partial thyroidectomy (meaning less than a near-total extirpation and gross residual disease), the role of RAI is unproven and the likelihood of morbidity is real. In terms of XRT, and in a patient with reasonable co-morbidities, I would offer XRT to 60-66 Gy. Keep an eye on spinal cord ...
For a GE junction tumor with a lymph node distant from the primary site, would the treatment volume be contiguous?
In general, a LN metastasis more cephalad to the primary GEJ tumor should be included as one contiguous volume with the primary tumor CTV. The rationale for this approach is that the lymphatic system of the esophagus is directly within the wall of the esophagus, so a LN metastases can skip up the es...
When do you consider it too late after lumpectomy to offer adjuvant whole breast radiotherapy?
The phrase, "The perfect is the enemy of the good" comes to mind...This is always a tough situation, but not uncommon in the "real world", especially with underserved patients. You hope that someone was proactive enough to place the patient on hormonal therapy if such a delay was anticipated. There ...
What is your advice to patients who ask if dental X-rays correlate with oral/oropharyngeal cancer?
No good data to support positive correlation between dental X-ray and oral/oropharyngeal cancer Bharat
Do you use breath hold techniques to minimize heart dose in whole breast radiation?
We do 2 CT scans (free breathing and deep breath hold) for every patient with left sided breast cancer treated in the supine position. We then create volumes and blocks for both scans and select the DIBH plan if it offers a clear advantage. Our approach is to attempt to keep mean heart dose under 1 ...
Is it acceptable to use SBRT for prostate bed RT?
In my opinion, this should not be done outside of an IRB-approved research study. We are beginning to see some published experience with moderate hypofractionation in post-prostatectomy patients, which would indicate, at least preliminarily, that this approach may be safe, although the optimal dose ...
Would you hypofractionate breast cancer patients with >25 cm separation?
According to the most recent ASTRO whole breast fractionation guideline, the decision to offer HF-WBI should be independent of breast size (including central axis separation) provided that dose-homogeneity goals can be achieved. The guidelines recommend that the volume of breast tissue receiving gre...
Do you treat with high-dose radiation alone (without ADT) for favorable intermediate risk prostate cancer?
We do treat so-called low-intermediate risk prostate cancer with RT alone (brachy alone or high dose IMRT). The critetia we use is GS 3+4, low number of cores being positive, non-palpable disease, and PSA close to 10.The impact of short term androgen ablation with high dose RT is not clearly defined...
What field and dose would you prescribe for a an extra-renal rhabdoid tumor of the pelvis?
Extrarenal, noncerebral rhabdoid tumors are relatively rare. However, the literature indicates an advantage for delivery of radiation therapy. Bourdeaut et al in 2008 reported on 26 patients with extrarenal, noncerebral rhabdoid tumors in whom the only surviving patient who had a proximal limb tumor...
Do you recommend hypofractionated/Canadian fractionation for in-situ ductal cancer?
The same pretzel logic used to deny hypo fractionation to patients with DCIS was used in the 80's to deny them breast conservation. It is not only reasonable to extrapolate the data from over 7000 patients with early stage invasive breast cancer on the British and Canadian trials, it is necessary fo...