Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the clinical significance of R50 in lung SBRT?
Small lesions are the hardest to plan and meet the constraints like the R50%. You are right that those parameters have not been associated with symptomatic pneumonitis. The only reliable predictor in retrospective studies has been increased PTV size. The R50, conformality index, and dose spillage va...
In what setting do you omit adjuvant radiation therapy in a T3N0 rectal cancer?
The 1990 NCI consensus guidelines recommend postop chemoradiation for patients with pT3N0M0 rectal cancer. However, that was before TME was routine. In patients with pT3N0M0 disease who undergo a TME and have at least 12 nodes examined, I do not recommend radiation. The benefit of radiation is a 3-4...
How do you approach muscle invasive bladder cancer in an elderly patient who cannot tolerate chemotherapy?
Although the ideal approach is chemoRT, if patient can't tolerate chemo (if cisplatinum is contraindiacted, 5FU amd MMC is an alternative), then RT to a definitive dose is a reasonable alternative. In the UK randomised study, the control arm of RT alone had about 50% LRC at 2 yrs. For patients with ...
Would you treat a muscle invasive urethral recurrence of bladder cancer with definitive chemoradiation?
Assuming that the urethral tumor is invasive of the prostatic stroma, there are multiple reasonable answers depending upon the patient's age and health status. Remember that stromal invasion is a bad sign and these patients are rarely cured. If the patient is young, but reluctant to consider cystopr...
For patients with low risk prostate cancer and with very large prostates (>80cc) with significant urinary irritative/obstructive symptoms at baseline, should a short course of neoadjuvant hormone therapy be used prior to EBRT to reduce the severity of urinary toxicity?
A not so straight-forward question, given the results of PIVOT that suggests the majority of low-risk prostate cancer pts don't benefit from radical treatment, and the REDEEM trial that explored the value of dutasteride in low-risk patients. One thing is clear, though, which is many pts have signifi...
What is your practice regarding axillary isolated recurrence after surgery when a patient received previous whole breast radiation?
I agree with @Dr. First Last on both counts. In the case of a deep, isolated, axillary recurrence, we start with NeoCT (based on the CALOR Trial data).Now, let's assume the patient has had prior comprehensive radiotherapy (breast and nodal), and now has smaller, but persistent isolated axillary dise...
Is there a role for prophylactic cranial irradiation in non-lung neuroendocrine carcinoma?
I think series with other sites are too small for any meaningful conclusion. The limited literature for small cell cervical cancer has not shown a high incidence of isolated brain metastases, but rather it has shown that it is usually part of metastases to other sites with lung being one of them. Fo...
What are your preferred dose/fractionation options for treatment of hemoptysis related to central lung metastasis?
50 Gy in 5 fractions every other day with SBRT.
When should SBRT be preferred in operative patients who cannot undergo a lobectomy?
Numerous retrospective studies have examined clinical outcomes between SBRT and surgery using a variety of different statistical tests- propensity analyses, matched-pair comparisons, multivariable analyses, and so forth. Collectively, these studies report conflicting results. No randomized data with...
When treating pancreatic cancer with adjuvant chemoradiation, do you treat the initial field to 50 Gy, as per RTOG 0848, or to 45 Gy?
What I do: R0: 50.4 Gy in 28 fractions 3D CRT with a field reduction at 45Gy off of the jejunal reconstruction as much as possible The 45Gy goes to the SMA, Celiac, porta and tumor bed. R1: (path says margin <1mm or postive, no soft tissue near SMA in CT): Boost to 54Gy with 3DCRT. R2: Gross disease...