Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you offer a boost for patients receiving 5 fraction whole breast radiation as per UK FAST Forward?
Any data (convincingly) supporting the use of boost comes from the non-hypofx era. In the START A/B trials (which included many "traditionally boostable" patients), boost/no-boost outcomes were analyzed (left up to each center's/doc's preference), and boost had an almost perfectly zero effect on out...
How would you treat a biopsy-proven isolated uterine cervix metastasis of adenocarcinoma from a known colon cancer primary, previously stage IIIb at diagnosis two years prior?
We have dealt with few similar cases in the past few years. The overall management will depend on the patient's prior history - did she get any neo-adj or adj radiation within the pelvis for prior cancer? How large is the cervix metastasis? A multi-disciplinary management is paramount with involveme...
Does your adjuvant radiation approach differ for ependymomas with RELA fusion?
Ependymomas (EPN) can occur either in the cord, the posterior fossa (PF), or supratentorially, and are found both in adults and children. At a very high level, the standard management consists of resection followed by radiotherapy. Although various chemotherapy regimens have been used in several set...
How do you dose concurrent chemotherapy with once daily radiation for bladder preservation in urothelial carcinoma?
Two contemporary trials which used daily radiotherapy and concurrent chemotherapy are BC2001 and RTOG 0712 with concurrent chemotherapy schedules as below. Other regimens such as platinum alone have been reported on as well.BC2001: 5FU: 500mg/m²/d d1-5 & d16-20 MMC: 12mg/m² d1 Rationale: The study...
How would you manage T4N0 NSCLC with two separate nodules in different ipsilateral lobes?
If there is no lymph node involvement and the two lesions are amendable by SABR, I would TX definitive with SABR for curative intent. The role of adjuvant TX is debatable, depending on molecular profiling and PD-L1 expression level. If not SABR, hypo-fractionated RT or concurrent chemo/RT could be c...
How do you approach a patient with unfavorable stage II Hodgkin's lymphoma who achieved cCR after 6 cycles of systemic therapy but developed acute pericarditis with non-malignant effusion after 2 fractions of consolidative radiation therapy?
Unfortunately, I've never had a patient develop such a condition during treatment and can therefore not provide you with any personal experience. I find it odd that this event developed after two fractions of RT and doubt if this is truly radiotherapy-related. Without having seen the treatment plan...
What volumes do you cover when delivering salvage radiation for a contralateral neck recurrence after upfront ipsilateral neck radiation for tonsillar cancer?
Levels 1b, 2, 3, 4, 5, and RP on the previously unirradiated neck.
Would you give whole-abdomen RT for preoperative rupture of favorable histology Wilm's Tumor treated with induction chemotherapy followed by GTR?
The short answer is yes, if you saw free fluid in the pelvis pre-treatment, and there were other signs of pre-operative rupture at the time of resection following chemotherapy, then WART should be considered.Given that the patient had positive LN at diagnosis, I would review the path report to see i...
What is the optimal sequencing of systemic therapy and consolidative thoracic RT for oligometastatic NSCLC?
I personally prefer doing sequential therapy first, for 3-4 months, then reassess for continuing oligometastatic state. This is how it was done in the Gomez randomized phase II study in which a PFS and OS benefit was observed. I think that by doing systemic therapy first some patients who are rapidl...
How do you use higher photon energies in your treatment of breast cancer with tangent fields?
Mixed energy use is very common in large breast to achieve dose homogeneity. In our dosimetric study, mixed energy use was about 65% with the goal to keep V105 low. The contribution from high energy can vary from 10-50%. Chen et al., PMID 29548340