Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you optimize HDR brachytherapy for intracavitary treatment of cervical cancer?
We do image based brachytherapy (MRI based). Start with standard weighting for point A dose and there after manually adjust dwell times to get D90> or = 100% and cumultative D2cc for rectum 65 Gy or less, Bladder 80 Gy or less and sigmoid 70 gy or less With weightedd planning, majority of times dose...
What is the recommended management for a large unresectable intracranial hemangiopericytoma?
Although beyond the scope of this discussion, it is important to recognize the evolution of the pathological classification of hemangiopericytoma. Solitary fibrous tumor and hemangiopericytoma are now considered histopathological phenotypes of a single pathologic entity. However, past studies typica...
How do you approach a lung malignancy with a single pleural nodule near a primary?
This is a relatively rare scenario. For example, in a Korean series of almost 4,000 patients undergoing surgery for NSCLC, 78 (2%) were found to have unexpected pleural seeding intra-operatively (Thorac Cardiovasc Surg 2018;66:142). A small number of surgical reports suggest, that when limited seedi...
Do you treat early stage breast cancer patients with hypofractionation in the prone position?
Yes as there is no reason not to do it
Would you de-escalate therapy for a prostate cancer that is barely high risk and has only 1 of 12 cores positive?
First let’s discuss high risk for cancer at the low-end of that category (example a T1c PSA6 1-2 core GS 8). Current standard of care for radiation management is to provide at least 18mo of ADT based on PCS-IV. This is somewhat of a dose de-escalation of hormonal therapy compared to EORTC regimen. ...
How do you manage early stage breast cancer in patients who can not have a surgery?
If the patient has life expectancy long enough to consider local therapy, you could consider hypofractionated radiotherapy. The Institute Curie reported 7-year cause specific survival and locoregional control over 95% among 29 early-stage breast patients treated with 32.5 Gy whole breast radiotherap...
What would your RT volumes be for a high grade sarcoma of a joint (such as the knee) after a gross total resection?
Receiving patients in the post-operative setting can be saddening knowing that a pre-operative regimen of radiation would be a lesser dose and volume resulting in a lesser chance of late-term toxicity as shown in the long-term follow-up of the NCIC study comparing pre-op versus post-op radiotherapy....
Do you recommend post-operative radiation therapy for gastric cancer after pre-operative chemotherapy when there is no pathologic response to chemotherapy?
There is no level one evidence to support such a recommendation. One could argue this point either way. The counterargument is that poor response to chemotherapy predicts poor outcomes in gastroesopheal cancer and a local therapy will not change that. That is certainly the case for GEJ ACA who all g...
How would you treat a patient with a solitary prostate cancer metastases in the mandible?
This would be a very unusual situation, as metastases to the mandible generally occur late in the course of the disease. I would want to be as certain as possible that this really represents prostate cancer, and would get a biopsy. The biopsy not only would confirm the diagnosis, but also permit you...
How, if at all, has the new DAHANCA H&N contouring guidelines changed how you delineate low dose CTV (CTV-P2) for head and neck cancer primaries?
I think it is important to keep anatomical boundaries for head and neck cancer. To depart from that is problematic for the primary disease site. My subclinical region always takes into account the anatomical likely site of spread. The 5 by 5 rule that the consensus guideline referenced is an old sch...