Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is post mastectomy radiation therapy indicated based only on pre chemo MRI and PET CT positive axillary lymphadenopathy, if surgery following neoadjuvant chemo showed CR ?
These patients are eligible for NRG-B51 to try to attempt to address this issue. My view on the trial is that observation is the experimental arm and radiation is the standard arm, so off trial I generally would offer post-mastectomy radiation, though there is room for flexibility depending on other...
Can a second course of SRS be used to treat a brain met that initially responded to SRS and then progressed?
One should use caution in interpreting imaging as a definitive sign of progression, as sometimes radiation necrosis can mimic those findings. if asymptomatic, the patient can be considered for close observation with imaging and if symptomatic, one should consider a surgical option also.
Regarding regional nodal irradiation for triple positive breast cancers, how much do you weigh in the availability of effective adjuvant systemic therapies (i.e, hormonal and anti-Her2 therapy) in theory being able to control subclinical nodal disease without the need for RT consolidation?
Some of these questions are unanswered, as systemic therapy has changed for the subset of breast cancer who are suitable for targeted therapy. That being said, with improved systemic treatment, the absolute benefit of RT may be small but this improved locoregional control may have a higher impact on...
When using short course fractionation for an elderly patient with glioblastoma (40 Gy in 15 fractions), what are appropriate dose constraints for chiasm, brainstem, optic nerves?
Dose constraints for normal tissues were not published in the randomized trial by Roa et al. of 40 Gy in 15 fractions vs. 60 Gy in 30 fractions for elderly patients with glioblastoma (Journal of Clinical Oncology, 2004). Given the apparent similar efficacy and tolerability of the hypofractionated an...
Is it preferable to offer hypofractionated SRT over single fraction SRS for brain metastases?
For bulkier lesions, or somewhat bulky lesions in bad locations (i.e. brainstem) I much prefer to use a 3-fraction approach, with admittedly less data to support it. We do, however, know that necrosis risks become significant with tissue V12 (single fraction) of >10-20 ml, so for patients with bulky...
Should lung SBRT fractions be delivered on consecutive days, every other day, or perhaps an even more prolonged schedule?
For North Ameridcan Radiaton Oncologists whose experience with lung SBRT began when they participated in one or both of the RTOG lung SBRT protocols (0236, 0813), they would have quickly learned that their patients would be classified as having either "peripheral" or "central" tumors based on the de...
Is there a benefit to adjuvant chemotherapy for patients with a solitary liver metastasis from previously treated colorectal cancer?
I know this question was asked last year, but for the record: Mark makes some great points above, but I respectfully disagree on using irinotecan in the post-met/micrometastatic setting. I don't feel the Ychou study provides enough support for this practice since there was no significant improvement...
Is it appropriate to treat patients with limited metastases with whole brain radiotherapy and a concurrent simultaneous integrated boost?
We have not done it but there are studies showing feasibility and good results.http://www.ncbi.nlm.nih.gov/pubmed/24674004
Is there an effective treatment for severe radiation fibrosis of the skin after radiotherapy to the breast or other areas?
I have used this regimen occasionally with moderate success. Worth a try. Topical Vitamin E as well can help.
In patients who are HPV postive, and non-smokers who have a complete PET response to induction TPF at the primary site, would you still treat the primary site to full dose?
Descalating therapy in HPV+ H&N SCC is the subject of investigation in ongoing clinical trials. Some are investigating de-escalation through the systemic agent used concurrently with RT (cetuximab vs cisplatin), such as RTOG 1016. Others are looking into the reduction of RT dose based on response to...