Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Should we be integrating tumor treating fields into standard glioblastoma treatment?
The EF14 trial preliminary results were just published in JAMA and demonstrate an improvement in both PFS and OS for the experimental arm, and the device has received FDA approval. In the neuro-oncology community, there is still anticipation regarding the final results (the entire cohort outcome dat...
Based on data from CREATE-X/JBCRG-04, would you consider adjuvant capecitabine in breast cancer patients treated with neoadjuvant chemotherapy who do not achieve a pCR?
Yes, 6-8 cycles of adjuvant capecitabine has been shown to improve survival in one randomized trial and therefore should be offered and disused with a patient. If capecitabine is given it could be given after surgery followed by radiation therapy or radiation may be completed first. Both options wer...
Which patients would you offer a watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer?
I would never offer watch and wait as an alternative, even in the patients with an apparent clinical complete response, and I would attempt to dissuade any patient from pursuing this approach. Even after apparent clinical complete response, we frequently see pathologic evidence of residual disease. ...
Would you consider whole breast irradiation in a woman who develops a second primary breast cancer or recurrence after lumpectomy and partial breast balloon brachytherapy and declines mastectomy?
In the case of a recurrence or second primary where the original irradiated soft tissue will be resected, I would first review the amount of dose delivered from the original APBI to the chest wall and skin. I am mainly thinking of APBI delivered with a brachtherapy technique. If the dose was more li...
Is there a role for docetaxel for men with high risk prostate cancer receiving radiation and androgen deprivation therapy?
Standard of care for high risk localized prostate cancer remains radiation and long term androgen deprivation therapy. To date, there are no trials that have demonstrated an overall survival benefit with the addition of chemotherapy. Given the potential toxicity of adding chemotherapy, this should n...