Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever recommend concurrent chemotherapy for high risk squamous cell skin cancer radiation?
Yes. The dose of radiation depends on the treatment scenario (adjuvant vs definitive). I generally follow NCCN guidelines, and give the same dose whether or not chemo is given. For bulky tumors, I might use a higher radiation dose if no chemotherapy is given. In general, the radiation dose is relat...
Do you use the PET scan hypermetabolic lesion to help contour the GTV for lung SBRT, especially in setting of peripheral atelectasis?
Merry Christmas/Happy Holidays Mednet. I'm sure there are faculty with a better set of credentials to answer this one, but since it's been on the list for a bit I'll compose yule log that can smolder in your mental hearths over the holidays. :) The short answer is yes. One of the commented benefits ...
What is the optimal management of recurrent seminoma with small volume retroperitoneal disease initially managed with surveillance?
The question is how to manage pathologic confirmed CSII seminoma. If the nodal volume is on the larger side (> 3 or so cm), most experts would treat those patients with BEP X 3 with a very high cure rate, with very low likelihood of requiring any post-chemotherapy interventions. Most experts in the...
What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?
It would be helpful to know the site of origin. Most stage I ALCL alk neg would be in the skin, in which case RT is the treatment of choice with little role for chemotherapy. Stage I ALCL, other then skin, would be quite rare with no data to guide us, except that we know response to chemotherapy for...
Do you treat fully resected squamous cell carcinoma of the ear with cartilage invasion with adjuvant radiation?
What were the margins? If sufficient (8-10 mm), I probably would not. I would certainly monitor the patient for lymph node metastases. Cartilage invasion is difficult to avoid for squamous cell cancer of the ear, so it is not surprising. Surgery is a better choice than radiation, unless so much cart...
Who is a good candidate for pre-operative SRS for resectable brain metastases?
In our study, the vast majority of our patients treated with pre-op SRS had tumor volumes between 5 and 35 cc (maximum dimensions of slightly above 2 cm to 4 cm). We do not treat patients who need emergent surgery for significant AMS or emergent hydrocephalus or herniation for example. Patients unde...
Is post-operative radiotherapy indicated in HPV associated, < 10 pack year smoking, low volume (i.e. T1N1) squamous cell carcinomas of the head and neck when the only adverse risk feature present on pathology is LVSI?
LVSI has been shown to increase the risk of regionally recurrent and metastatic disease as an independent risk factor (and even worse in terms of DFI and DFS in patients with concurrent PNI). The question I'd ask is what is the appropriate volume of disease to treat. These days we are minimizing our...
When does perineural invasion for a squamous cell carcinoma of the skin of the head and neck merit adjuvant radiotherapy?
In cutaneous squamous cell carcinoma, the presence (vs absence) of perineural invasion is associated with a higher likelihood of local tumor recurrence after a margin negative excision. However, several recent studies have shown that for small caliber perineural invasion (invasion of a nerve <0.1 mm...
When do you prescribe steroids prior to palliative radiotherapy of bone metastases to prevent pain flare?
Thanks for the interesting question. The dexamethasone was given 8mg one hour prior to single fraction radiotherapy (RT), then 8mg po daily with breakfast for four days subsequently (not five days prior to RT). A steroid taper was not utilized. Previous studies by this trial's PI investigated both a...
In light of the 2015 ASTRO plenary session presentation about involved-field radiation vs elective nodal radiation therapy, are you including elective nodal fields (celiac, mediastinal, supraclavicular) in the treatment of locally advanced esophageal cancer?
In the Chinese study presented at ASTRO, the ENI volume treated included mediastinal levels 4,5, and 7 for any thoracic site of disease (upper,middle or lower) with some other levels added based on location. In practice, and in most studies published through RTOG, the radial margins are 1.5 to 2 cm ...