Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How should radiation oncologists respond to the recent meta-analysis concluding that prostate cancer-specific mortality is lower following prostatectomy vs radiation therapy?
Prior comparisons that suggested equivalence with surgery and dose escalated RT focused on biochemical control. However, with longer follow-up, comparative studies suggest superiority for surgery over EBRT for the harder endpoints of metastasis and cause specific survival. This is most evident among...
What SRS dose do you use for secreting and non-secreting pituitary adenomas, respectively?
After central debulking, would you use SRS for a 1 cm residual GH-secreting adenoma in the cavernous sinus and along internal carotid artery? If so, what dose? What would you estimate risks of cranial neuropathy or vasc injury with SRS?
In what situation, if any, should a proton boost be used to boost gross disease in head and neck cases?
Good question. It reminds me of when IMRT was newer, and our practice at UCLA was to give 5 weeks of 3D conformal radiation to whole pelvis, reserving IMRT for the prostate boost portion.@Dr. First Last and I looked at the outcomes, and they didn't seem much different, toxicity-wise, than those who ...
Is there any role for adjuvant radiation for a low grade, intraductal papillary mucinous neoplasm (IPMN) of the pancreas after resection with a positive pancreatic margin?
There is no defined role for adjuvant treatment of IPMN with or without positive margins. This question illustrates an interesting concept that can be applied now that we are in the era where ablative doses of radiation can be given*. Regardless of the tumor site, the margin in question is not near ...
How often should a patients patient's pacemaker/ICD be interrogated while they are undergoing a course of radiotherapy?
There is no simple answer to this question. The frequency of the interrogation should made in concert with a experienced cardiologist/electrophysiologist. Factors that play into the frequency of interrogation include an estimation of the consequences of device failure and the likelihood of device fa...
What are your criteria to determine if there is a local failure versus post treatment changes after SBRT for inoperable early stage NSCLC?
I agree with Craig. Additionally, it's worth a biopsy when those conditions are met. In our early experience the biopsy was negative (and the patient didn't progress) in 50% of the patients. Through the subtle dark arts of academics I've published 2 case reports that were particularly interesting. :...
For patients with brain metastases, do molecular subtypes influence your decision to use SRS versus whole brain radiation?
This is an excellent question and the decision of SRS or WBRT in this setting has significant clinical ramifications. All things being equal, in the situation as described, I would recommend SRS for up to 10 brain metastases in a patient with a good KPS and good systemic therapy options (targeted th...
Is there a field size in which you would consider single fraction palliative radiation unsafe?
There is nothing to suggest a larger field size when treating multiple body levels increases the risk of complications with 8 Gy single fraction. Radiobiologically it is less dose to cord than 30 Gy in 10 fractions. We routinely use it. Only if a large GI volume gets treated small bowel or stomach) ...
What are the appropriate dose-fractionation schedules for patients being treated with EBRT as opposed to SRS for an acoustic neuroma?
While we can argue about SRS versus FSRT all day, I think the data is slightly more clear with fractionation schedules. At Thomas Jefferson, my previous institution, we favored fractionation to 46.8 Gy in 1.8 Gy fractions for patients with serviceable hearing as this regimen has shown excellent tumo...
Can close surveillance be used to manage an intracystic papillary carcinoma that is associated with a small amount of low grade DCIS?
Intracystic papillary carcinoma, although by nomenclature is carcinoma, it has a behiavior like low grade DCIS and occurs in elderrly. Our treatment principle is very simailr to what one would do for DCIS.