Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In what cases of T3N0 glottic SCC, would you omit chemotherapy and offer radiation alone?
The question seems to stem from a presentation of a patient that would have historically been stage 2, but more recent editions of AJCC and more refined imaging have upstaged the patient to stage 3 by calling minimal paraglottic extension on an MRI. This is similar to a previous question where a pat...
Do you include a dural CTV margin for intact brain metastases touching the dura when treating with SRS or fSRT?
Typically, for definitive SRS cases, I have not included a significant CTV margin beyond the tumor in cases where there is dural contact. This is mainly considered in post-operative cases per the ISRS guidelines, where there is a known high risk of nodular meningeal/dural failures with initial surge...
How do you approach anti-seizure medication management when it was started by another team for a seizure-naive patient before/after craniotomy for a tumor?
I would refer you to Dr. @Dr. First Last's answer to a similar question (https://www.themednet.org/question/15031) which beautifully summarizes data and guidelines. I usually counsel patients that everyone regardless of their medical history has a certain risk of seizure under physical stressors, th...
Is 10 Gy x 5 an acceptable dose to use for lung SBRT in tumors with favorable location (eg. not central and not encroaching on the chest wall?)
The paper cited, which my colleague Kevin Stephans authored, used our large institutional data base with long term follow up to carry out a retrospective review of BED adjusted SBRT schedules and showed no difference in overall survival, but slightly improved local control, with higher BED schedules...
How would you manage a patient with a rapidly growing, clinically localized breast cancer who is medically inoperable?
I would consider chemoRT for a medically inoperable breast cancer. Here is a prospective trial (https://www.ncbi.nlm.nih.gov/pubmed/20878462) that used paclitaxel and radiation to treat locally advanced breast cancer in the pre-op setting. I use this in the palliative setting for medically inoperabl...
If blood counts are being checked during concurrent chemoradiation, is there a number at which point you would recommend a radiation treatment break?
I’ll let the platelets go as low as 10K before stopping. I lean heavily on the rate of decline to intervene with a break sooner than the absolute numbers if heading for trouble and later if decline is slow and at reaching the end of treatment.
Is multifocal disease an indication for RT in an elderly patient with early stage and otherwise favorable breast cancer?
Agree with above, though I did just see a healthy woman in her early 70s with a two site lumpectomy for two favorable small tumors. Though RT will not improve OS, I expect the cumulative risk for LR is likely higher for her (given the two sites have an independent risk for recurrence), and I leaned ...
What total dose do you use for a close and positive breast cancer margin that cannot be re-excised?
Based on consensus guidelines, there is no such thing as a close margin as HR for recurrence did not change based on margin width. That was the reason for group to conclude that no tumor at inked margin is a negative margin (except for pure DCIS or those who had neoadjuvant chemo).If we give a boost...
Should special precautions be taken patients with Ehlers-Danlos syndrome receiving radiation therapy?
Not all EDS is the same. Most commonly, an EDS patient these days is a clinically diagnosed patient with hypermobile joints, possibly stretchy skin, and possibly chronic pain syndrome. That is a very different picture from vascular EDS with a COL3A1 mutation, which is rare and would have the extreme...
Do you counsel patients differently about the risk of radiation induced malignancy when you are treating a proximal joint (hip) vs a distal joint (elbow) for benign conditions such as OA?
The mentality for this must change from radiation oncologist thinking to radiation medicine thinking. There have been no documented cases of malignancy from LDRT treatment of OA. Those who worry about the spine reference old studies giving 20 Gy in 5 fx with an open field pre-linac era. This is not ...