Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose do you recommend for salvage radiotherapy after biochemical recurrence in prostate cancer?
We normally give dose of 66.6 Gy which should be sufficient for microscopic disease. In patients where there is imaging suggesting recurrence or the pre-RT PSA is high then we consider going to 70 Gy for a high volume of disease while taking normal tissue dose into account.There is data for dose esc...
How do you deal with wounds in or around the radiation fields?
Agree with @Dr. First Last completely. As another example, a slowly healing drain or mastectomy wound that remains open during chemotherapy will often close during radiation, despite being within field. I monitor and continue standard wound care, but do not change my treatment fields.
If a patient with a seminoma fails after chemotherapy in the paraaortic nodes, what is the best salvage therapy - different chemotherapy or radiation?
It depends on what the prior intent of chemotherapy was, what type it was, how confident you are that the patient has indeed relapsed as well as the size of the nodes. Three scenarios might be considered. If the patient received adjuvant carboplatin, somewhere between 5 and 10% will relapse and 75% ...
How do you approach treatment for isolated vaginal cuff recurrence of endometrial cancer in a patient previously treated with adjuvant vaginal cuff brachytherapy?
We take previous brachy dose into account. If the patients have a CT based plan from their previous brachy, then we calculate the 2 cc dose to rectum and bladder from previous RT. Based on that dose, we deliver 30-36 Gy to pelvis including entire vagina, paravagina and nodes with EBRT, and after tha...
When giving palliative lung radiation to a patient on immune checkpoint blockade for NSCLC, do you hold immunotherapy?
Most of the palliative lung RT regimens include either 3000 cGy in 10 fractions using 300 cGy per fraction or 3500 cGy in 14 fractions using 250 cGy per fraction. As the experience is limited on the concurrent use of palliative RT with immunotherapy, I withheld immunothearpy while treating the lung ...
Can any non-SBRT hypo fractionation regimen for prostate cancer be regarded as the new standard of care, or as an equal alternative standard of care?
RTOG 04-15 (N = 1092) – W Robert Lee et al. Disease state: Low risk PC Randomization: 73.8 Gy RT in 1.8 Gy fx’s versus 70 Gy RT in 2.5 Gy fx’s (Non-inferiority design) Median Follow up: 5.8 years Toxicity: Significant increases in both Gr 2 + and Gr 3 + late GI and late GU toxicity with hypofraction...
Which, if any, aspects of your management of prostate cancer differ in your African-American patients versus those of other racial/ethnic backgrounds?
My short answer is that I do not treat patients diagnosed with prostate cancer differently based on race or ethnicity. There is data to support a higher risk of progression on active surveillance among African American men as compared with Caucasian American men with low risk prostate cancer, but th...
Should 4 Gy x 5 be the standard of care for spinal cord compression in patients with poor prognosis?
Wow, so this question was asked in 2016 and nobody has taken a whack at it. 30 Gy in 10 fx has been the long-standing standard dose for SCC in most countries for just about ever. This has not been compared to other doses until more recently. 30/10 works well, is relatively short (2 weeks), and utili...
How do you manage an open wound that is not healing after radiation treatment for an ulcerated SCC of the scalp?
There always has to be high suspicion for persistent disease, so consider a punch biopsy. Sometimes repeat biopsies are needed to confirm recurrence. Sometimes localized surgery without general anesthesia can be performed to freshen the wound and promote graft placement. Tertiary centers may have ex...
Does infra- versus supra- tentorial tumor location change your management strategy for the treatment of single brain metastases?
My experience has been that there is a greater risk of vasogenic edema after SRS to the posterior fossa due to the anatomical constraints. If there is marked mass effect from the lesion, I push the surgeons to resect followed by conformal XRT to the tumor bed. Otherwise, I have treated many posterio...