Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should post-op RT be delayed for children < 3yo after a GTR resection for a posterior fossa or supratentorial ependymoma?
Standard of care for a GTR posterior fossa ependymoma of any histologic grade is immediate adjuvant radiotherapy. If a STR is encountered, chemotherapy may be considered to try and facilitate a second look surgery. The current protocol allows patients with supratentorial ependymomas that have receiv...
What is the value and potential morbidity of second look surgery in patients with sub-totally resected ependymoma?
Since gross resection of ependymoma is associated with improved prognosis, chemotherapy is frequently used to render sub-totally resected ependymoma potentially resected totally during second look surgery (thereby improving prognosis). One of the main reasons that the tumor in the posterior fossa is...
Do you consider 1.8Gy and 2Gy fraction sizes completely equivalent when performing whole breast radiation therapy?
Although they probably are, I tend to use 1.8 Gy for conventional treatment. Given how well women do with 2.66 Gy with hypofractionated regimen, it seems logical that a 2 Gy fractionation should be just as well tolerated.
For early stage NSCLC to be treated with SBRT, is there any difference in the technology being used such as robotic v. linac based VMAT?
In my opinion, as long as the SBRT team can follow the principles and safety measures, there shouldn't be any difference in treatment outcomes and toxicities among different treatment devices for early stage NSCLC. In other words, the expertise of the team is much more important than the treatment d...
Are there certain clinical scenarios that make you favor a lower whole breast total dose but higher lumpectomy cavity boost?
In patients with large breast size where dose homogeneity is not optimal we do 45 Gy in 25 fraction to breast and 16 gy boost for total dose of 60 Gy to the surgical bed site.
What is your preferred dose for definitive radiation of squamous cell cancer of the thoracic esophagus that will be combined with chemothererapy?
We normally plan for 50.4 Gy to 59.4 Gy based on tolerance, realizing the fact that RTOG didn't show a benefit for more than 50.4 Gy. The European studies which compared triple modality to chemo RT delivered dose in 60s and, although they showed feasibility, they did report high stricture rates.
In which patients receiving regional nodal irradiation do you include the internal mammary nodes?
I think the study adds to the body of literature supporting regional nodal irradiation as contributing to survival, breast cancer mortality and disease free survival in high risk breast cancer. This study suggests that there is an incremental benefit associated with inclusion of the internal mammary...
What prostate size or baseline urinary symptoms are relative contraindications for prostate HDR?
Prostate volume has been a limiting factor with permanent seed brachytherapy in some patients with a large prostate and a narrow pelvic inlet. A prostate volume >60cc is used by some as a relative threshold, but is not tightly adhered to by many experienced brachytherapists. With permanent LDR prost...
In the IMRT era, what role does brachytherapy play in the treatment of squamous cell carcinoma of the vulva?
We very rarely use brachytherapy to treat vulvar cancer because our experience (and that of others) has been that the rates of necrosis with brachy are very high. Any source that comes too close to the vulvar surface will cause necrosis that typically heals very slowly. Even with the best technique,...
What treatment recommendations for a low or intermediate risk prostate cancer do you consider when treating patients with medical commodities such as ankylosing spondylitis and ulcerative colitis?
I do not think either of these would be a contraindication for radiotherapy. I have some experience with patients with ulcerative colitis, but not with ankylosing spondylitis. If there is any concern, either HDR or LDR brachytherapy are the most attractive options. The volumes for low and intermedia...