Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?
Although myeloma is radiosensitive, since it has caused metastatic epidural spinal cord compression, I will still offer 30 Gy in 10 fxs or 37.5 Gy in 15 fxs, a dose closer to a definitive dose for plasma cell tumors, in order to provide a more durable local control. See variant 2:ACR appropriateness...
Do you recommend holding a TKI when treating brain metastases with SRS/WBRT?
There are a few publications which help address this very pertinent question. The phase 3 trial of whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone versus WBRT and SRS with temozolomide or erlotinib for non-small cell lung cancer and 1 to 3 brain metastases: RTOG 0320 (...
How would you manage a localized low grade follicular lymphoma diagnosed shortly after a patient had a CR to an aggressive treatment regimen for DLBCL?
DLBCL arising from a low-grade lymphoma, typically follicular lymphoma, is relatively common. It occurs at a rate of 2-3%/year. Presumably, in this case the patient had an undiagnosed FL with early transformation. Review of the pathological specimens may shed light on this possibility. In any case, ...
Do you adjust your lung DVH constraints when treating a patient that has lobar atelectasis due to tumor obstruction?
Currently the answer is no. Obstruction is not necessarily improved after RT and greatly depends on the time the lung has been down. I currently assume that the collapsed lung is potentially functional and take it into account when determining lung volumetric constraints. This assumption may change ...
What is the best treatment management for a metaplastic carcinoma of the breast (such as adenosquamous)?
We have been treating with adjuvant RT follwing same principal as other breast cancer type as data is limited . These tend to be triple negative by IHC but there response rate with chemo is low and not like ductal triple negative cancers
How do you approach teeth extractions for head and neck cancer patients getting radiation?
Here is what my oral surgeon, who deals with ORN, told me: “We do implants in fields of high does radiation. The risk of immediate and long term failure is higher but often the risk/benefit still weighs in favor. I have two patients that have devoleped ORN (one immediate and one late) after implants...
Do you recommend using altered fractionation for a patient with squamous cell carcinoma of the skin in the head and neck region who cannot receive concurrent chemotherapy?
In an octagenarian who cannot undergo surgery or chemotherapy, I would be reluctant to use an accelerated curative-intent radiotherapy regimen. This is primarily because meta-analyses of altered fractionation mucosal head and neck cancer have shown limited improvement in outcome over conventionally ...
How do you manage musculoskeletal pain in men receiving androgen deprivation therapy for non-metastatic prostate cancer?
This a very good question. Because bone pain can be a symptom of "benign" bone health issues without bone metastasis and because of the patient population demographics including risk factors, we obtain baseline bone health screening on most patients who must undergo Androgen Deprivation Therapy (ADT...
What is your preferred approach to young adults with CNS pure germinoma (markers negative, single nodule, CSF negative)?
This is a great question as we tried to evaluate the benefits and trade-offs between both approaches with ACNS0232 but the study closed prematurely because of poor accrual. As with many other studies that have drastic differences in the strata which are randomized, it can be tough to ask patients an...
Does radiation improve bone health and allow for healing of a pathological fracture in a patient with multiple myeloma refusing surgery?
Radiation for myeloma lesions does allow for recalcification of lytic lesions about 50% of the time. There is a suggestion that higher doses increases the degree of recalcification (increasing doses from 20 Gy to 30 Gy increased recalcification by 12% according to Matuschek C et al. Radiat Oncol. 20...