Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When is it too far out from CRT to the chest to be considered for PCI for limited-stage SCLC?
How about this answer that was not listed - "don't give it!" The evidence we hang our hat for PCI in SCLC is not just weak, it is also outdated. With the medical technology available they had at the time, it made logical sense that staging would miss brain metastases. ~50% of the studies in the meta...
Would you offer PMRT after NAC in a boderline patient with a pCR based on suspicious pre-chemotherapy IM nodes?
We do run into this situation, ecspecially in the MRI era, when it picks up the IM nodes. Older data with MRI imaging suggested if node is more than 5 mm the likelihood of disease based on bx was more than 90%. With advancement in MRI now 5 mm node have been reported in benign breast disease also. W...
What are your indications for treating a pelvic desmoid tumor in a young woman concerned with fertility?
I would generally try to avoid radiation therapy in desmoid tumor unless it is symptomatic and not responsive to medical management and/or surgical management. Although unresected desmoid tumor can respond to radiation therapy with doses in the 55 to 60 Gy range, I would avoid it in a young woman co...
What is the sensitivity of SLNB after neoadjuvant chemotherapy for cN0 patients?
The sensitivity of SNLN for clinical N0 disease is high and can be treated like node negative. One has to be cautious about clinical positive patients which normalizes after chemo, as based on ASOCOG and SENTINA trial it can be less than 90% unless due diligence is done like clipping the involved no...
How do you delineate target volumes for patients who receive induction chemotherapy prior to definitive chemoradiation for locally advanced head and neck cancers?
We almost always evaluate our patients prior to start of induction chemotherapy (unless referred from outside) for a physical examination and ordering all diagnostic tests. The main principle to keep in mind is that all pre-chemotherapy extent of the disease should be included in the treatment volum...
Do you prefer a chemo-radiation combination or chemotherapy followed by sequential radiation approach for early stage NK/T-cell lymphoma?
If SMILE regimen is used here (the preferred regimen for NK/Tcell lymphoma), radiotherapy should be delivered sequentially (not concurrent) due to normal tissue toxicity and poor tolerance.
Would you recommend APBI in an otherwise "suitable" patient who has had a previous history of estrogen replacement therapy prior to early stage breast cancer diagnosis?
I have not used that as contraindication to APBI. Also there is no outcome data that I am aware of which shows stage for stage there is difference in recurrence pattern.
Would you consider maintenance therapy for patients who achieve complete response after palliative chemoradiation for metastatic distal esophageal adenocarcinoma?
There isn’t much evidence in this setting. I definitely consider chemotherapy and radiation in patients with small burden metastatic esophageal adenocarcinoma if they have significant dysphagia. Chemotherapy and radiation in the end is the most effective way to palliate dysphagia. I do however also ...
What dose regimen do you use when a women with inflammatory breast cancer is not responding to chemotherapy and needs radiation prior to surgery?
The data suggest pre op RT can convert some of these inoperable patients to surgery. I use comprehensive RT to preoperative dose of 50 Gy in 25 fractions in these patients
How do you simulate and treat prostate cancer patients on dialysis receiving EBRT?
This is a great question and agree that the fluid restriction needs to be taken into account. Talking to the patient's nephrologist and cardiologist can be helpful. Having spoken to nephrology and cardiology on patients on dialysis, if the patient does not have heart failure it can be easy to still ...