Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
If a SNB is positive after neoadjuvant chemo and mastectomy, should an axillary dissection be performed or xrt given to all?
Just to clarify, the Alliance 011202 study takes patients with involved axillary nodes before induction chemotherapy who fail to convert to node-negativity post-induction, and randomizes them to axillary dissection vs not. Everyone on the trial gets comprehensive regional RT. There are options for i...
Is it safe and appropriate to palliatively treat abdominal or thoracic tumors with concurrent chemotherapy when using fractions of 250-300 cGy?
I have routinely given 250cGy per fraction to total doses of 3500-3750cGy with single-agent radiosensitizing chemotherapy (usually 5-FU or capecitabine) without apparent significant toxicity, though we have not reviewed our data. So I generally consider this to be a safe regimen and consider it for ...
What RT margins do you use when treating Grade III anaplastic gliomas?
At the Cleveland Clinic, we extrapolate from the GBM literature and from the Cairncross RTOG 9402 and Van den Bent EORTC trials showing the benefit of chemotherapy, and thus deliver radiation with concurrent temozolomide. We typically treat to 5940 cGy in 33 fractions. We treat PTV1 to 5040 cGy and ...
What is the most accurate method to determine initial tumor size prior to neoadjuvant chemotherapy and mastectomy?
The pattern of regression after neoadjuvant chemo is not always consistent. It could be concentric where the tumor regresses uniformally in all direction and thus the final tumor is unifocal and much smaller than imaging (percentage regression suggests the degree of response to chemo). Or it could b...
Do you re-irradiate for heterotopic ossification in patients who re-develop ossifications?
There is not much on this subject, but we have retreated patients using 7 Gy in 1 following revision surgery without any obvious detriment.
Can the addition of posterior axillary boost (PAB) for breast cancer increase the risk of brachial plexopathy?
In the era of 3D volume based planning, it is important to contour the nodal regions and optimize coverage to the volume. In the 2D era, people use to prescribe to mid axilla and a PAB was commonly used. We know now that axillary nodes are far more anterior then that. To cover these nodes, we use an...
How do you manage patients with early stage breast cancer with autoimmune disorders such as rheumatoid arthritis and collagen vascular disorders?
The historical perspective has been to treat in 180 cGy daily fractions to a total dose of 45 Gy with a tumor bed boost (assuming the need) to 50-55 Gy based on intrinsic increased radiosensitivity of normal and tumorous tissues. It is unclear whether this dose-fractionation schedule is effective be...
How are patients on anticoagulation managed in the context of intracranial SRS?
At our institution, we do not withhold heparin or warfarin prior to treatment. This risk of intracranial bleed is not felt to be increased as a consequence of treatment. We do use a traditional headframe (using pins to hold to the skull). While there may be an increased risk of bleeding at the pin s...
Would accelerated hypofractionated whole breast irradiation therapy be contraindicated in a patient opting for breast conservation in the setting of breast implants?
I would say it is not contraindicated. In the clinical studies comparing conventional to hypofractionation, they did not report any increase in late effects on skin or subcutaneous tissue. Rather, in START B it was less for hypofractionation possibly because of lower total dose. The most important a...
For post-op H&N cancers, do you get CT neck with contrast prior to sim?
I do not routinely order CT or MRI Neck prior to simulation, but our department is equipped to do IV contrast with our CT simulations. I try to use contrast with all of our H/N sims because it can help delineate target volumes, though it is not absolutely necessary. Our radiologists do not read our ...