Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose would be appropriate for large intra-abdominal or retroperitoneal sarcomas that are unresectable?
I think this is a very difficult question to address. If medically inoperable, the nature of the inoperability is essential and the comorbidities would need to be balanced against the potential morbidity of sarcoma progression (and thus grade matters) and treatment. If surgically inoperable, I would...
What healthcare blogs should radiation oncologists be reading?
Weblogs, more commonly called blogs, come in many forms. The best ones to follow depend upon your interests and which platforms you like best. Twitter is a micro-blogging platform. So for brevity I'll focus on 'traditional' blog formats using Blogger, Wordpress or similar software. General Healthcar...
What is the absolute maximum lung V20 that you will accept for patients undergoing chemoradiation for locally advanced lung cancer?
Here's how I start with those high V20 plans: I usually do a 4D CT, then make ITVs. I use a 7mm CTV for primary lung and a 3 mm CTV for nodal disease. Using a Boolean function it's easy to put them together for a CTV6000 and then expand that by 5 mm. We do daily CBCT for alignment and I think 5 mm i...
What surveillance imaging is appropriate after spine SBRT?
All of us have our own formulas. I tend to see patients about 2 months right after spine SBRT, then every 3-4 months thereafter. While most patients I continue with every 4 month follow up beyond two years, there are times that I space that out to every 6 months depending on the clinical circumstanc...
For a patient with inflammatory breast cancer after standard initial systemic therapy with only a partial response, do you recommend more systemic therapy, pre-operative radiation, or proceed to modified radical mastectomy?
If the disease is operable with a partial response, then we proceed with surgery. Otherwise, we try a different chemo regimen and sometimes preoperative RT to make it operable.
Do you offer hypofractionated accelerated whole breast radiation therapy for women receiving trastuzumab during RT, particularly those with left sided primaries?
In the modern era for breast RT the radiation field should not be transversing through heart (a conformal block, the prone position or DIBH technique can help prevent radiation to the heart) and with one of these techniques mean heart dose is 1 to 2 Gy (most of this dose comes from scatter or transm...
When should intermittent androgen deprivation vs continuous androgen deprivation be used for the treatment of prostate cancer?
I think the question posed and the patient example are really 2 different questions. To address the title question, let me call your attention to a recent article in the JCO 34: 280-5, 2016, and an accompanying editorial, which review this issue in detail. The authors point out that there are signif...
Is SBRT an appropriate treatment for recurrent and unresectable spinal ependymoma?
We have reirradiated a handful of patients who had 45-54Gy to the spinal cord 5-12 years ago with another course of RT 50Gy/25 to the cord without any neurologic sequelae--this is unpublished (we are working on it). We have also reirradiated small recurrences after a full course of RT to the spinal ...
Are there situations in which elective nodal volumes may be reduced for T1/T2N0 anal SCC?
I have treated several elderly patients with small tumors using this low dose, limited field regimen. All did well. Involved-Field, Low-Dose Chemoradiotherapy for Early-Stage Anal Carcinoma Paul Hatfield, M.D., Ph.D., F.R.C.R., Rachel Cooper, M.D., M.Sc., F.R.C.R., David Sebag-Montefiore, M.D., F....
In patients who are medically poor surgical candidates, what are the treatment options available for bulbomembranous urethral cancer?
The evidence is thin, but these patients may be treated by chemo-radiation. Whether they are urothelial cancer or squamous cell carcinoma the aim would be to get in a worthwhile radiation dose, say 65-70Gy, with reasonable sensitizing chemotherapy if they have the kidneys to tolerate it. Sometimes t...