Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the flank radiation dose for recurrent Wilms?
For children with recurrent Wilms who had NO treatment with either chemo or RT, we recommend the lower doses mentioned in AREN0532 (NCT00352534). All treatment- recurrent Wilms should receive higher doses as stated in NWTS5 (NCT00002611).
Do you block kidney to meet kidney constraint when treating Wilms with diffuse unresectable peritoneal implants?
Yes, either block or use imrt.
What are the indications for RT for an alveolar FOX01 fusion positive, paratesticular rhabdomyosarcoma s/p radical inguinal orchiectomy and PLND showing pN0, group 1, stage 1 disease?
We have not radiated in this specific scenario. While there are still questions about the need and benefit for adjuvant RT in patients with completely resected alveolar histology or FOXO1+ disease, the absence of a clear target in patients with paratesticular primary involvement with complete resect...
How would you treat laryngeal neuroendocrine carcinoma?
It would depend on extent and differentiation. If small cell, chemo RT. No point in surgery because they almost always develop distant metastasizes. If differentiated, it would depend on extent and surgical alternative.
Would you consider lymphovascular invasion at the margin to be a positive margin in breast cancer surgery?
LVI is an independent risk factor for local relapse despite adequate treatment. That being said, we don’t chase LVI to get negative margin as it is non contiguous involvement and not contiguous process which warrants any reexcision.
What brachial plexus dose constraints do you apply when treating conventionally fractionated NSCLC?
Yes. I am presuming you are discussing treating definitively with CRT for locally advanced NSCLC.Since RTOG 0617, most people that treat NSCLC prescribe to a dose of 60-66 Gy in 30-33 fx, as this is a feared toxicity that is very painful and decreases QOL. We try to keep the brachial plexus dose to ...
In what head and neck subsites, if any, would you recommend adjuvant radiation s/p high quality neck dissection if pN1 disease (single ipsilateral LN <3cm) was the only risk factor?
The societal guidelines are all over the place. I will consider PORT in pN1 patients without other pathological risk factors if the primary was oral cavity. Oral cavity primary is, itself, a risk factor for locoregional recurrence (Peters et al., IJROBP 1993). Various retrospective studies have sugg...
How do you approach hotspots/heterogeneity for palliative radiation plans?
For whole brain, hotspots are usually located superiorly, where the head narrows.Some options to reduce include: higher energy/mixed beams and supplementing the laterals with field in fields to keep the hotspots lower than 110%. Mixed energy plans look very nice, but consider contouring a brain CTV ...
For a patient otherwise suitable for APBI, would neoadjuvant endocrine therapy administered for extemporizing reasons (e.g., COVID diagnosis and recovery, rather than downstaging) preclude consideration of APBI?
I have not typically treated patients with APBI if undergoing neoadjuvant therapy (chemotherapy or endocrine therapy). In theory, if endocrine therapy was a short amount of time, PBI could be considered but I have favored HWBI in these situations.
When would you include the superior mediastinal lymph nodes when treating head & neck cancer and how do you define the target volume?
Low level 4 and/or 6 nodes.