Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Have we established standard doses for radiation therapy for H&N cancers?
You've asked a *really* wide-ranging, thought-provoking question. That said, if by 70 Gy you mean 35 fractions of 2 Gy apiece over 7 weeks as *the* "optimal dose," I can think of a few references off the top of my head where that's not optimal per se. Dosing also entails the timing/frequency of dose...
What challenges and adverse effects have you encountered with SpaceOAR injection?
Only situation in our limited experience where we have encountered a problem is in a patient with inflammatory bowel disease that had a j pouch where the scarring limited optimal placement of the SpaceOAR and the separation between the rectum and prostate was not as desired.
What is your preferred dose-fractionation regimen when treating high-risk SCC of the skin in elderly and/or frail patients?
Treatment considerations for patients with cutaneous squamous cell carcinoma are multifaceted and require assessment of patient (age, transportation logistics, desired cosmetic outcomes), disease (size, location), and treatment factors (electron energy, cut-out size, bolus, choice of prescription is...
Would you offer radiation to an elderly patient with DCIS who would otherwise not meet criteria for RTOG 9804?
I counsel elderly patients with DCIS about the risks and benefits of receiving radiation therapy. I offer radiation in patients with excellent performance status who are uncomfortable with the 1-2%/year recurrence risk with omission of radiation (extrapolating from RTOG 9804 as well as ECOG (Solin e...
How do you treat a radioresistant (e.g. RCC or melanoma) oligometastases in a weight-bearing bone after surgical resection and stabilization?
Let's assume we are dealing with a femoral met. If the surgeon just puts an intramedullary (IM) nail through the tumor (tumor not resected), the whole length of the nail will have to be treated as it carries the tumor cells with it as it goes down through the medullary canal. In this situation, exte...
What treatment volume should be included for a resected glioma with a large hygroma adjacent to the resection cavity?
In general, post-operative hydroma is considered as part of surgical cavity/postoperative change. As a result, it is included in the radiation target volume. The histological grade generally doesn't impact the decision, unless, it is a WHO grade I pilocytic astrocytoma. In such case, we could consid...
Do you offer bladder-sparing approaches as an alternative to cystectomy for surgery-eligible patients with muscle-invasive bladder cancer?
We have a bladder cancer multispecialty clinic at SCCA/UWMC in which we also see patients with localized MIBC and we balance carefully risks vs benefits, rationale, data, details & logistics of options. Overall, cisplatin-based chemotherapy (for fit patients) ->radical cystectomy with PLND, OR maxim...
Is there a role for a salvage lymph node dissection in patients who present with a biochemical failure after prostatectomy?
It's an important question without randomized data to support an answer. Even this question will evolve as we bring on-board more advanced imaging such as Fluciclovine PET/CT, PSMA PET, etc. These scans are continuuing to introduce new challenges as we start to resolve the location of lesions and so...
Which chemotherapy regimen (if any) do you recommend for palliative concurrent chemoradiation for a symptomatic patient with metastatic cervical carcinoma and CKD stage 4 (GFR 15-29)?
For patients who cant get cisplatin because of poor kidney function, we have used taxol at 45-50 mg/m2 weekly ( metabolized through liver) based on phase 2 data. In our experience it is tolerated well.
When do you use IMRT in breast radiotherapy?
We seldom use it. Our limited dosimetric experience shows that even though coverage of regional nodes improves, the V10 and V20 of the lung and the mean heart dose also increase. Thus, the small benefit of improved coverage (EORTC and Canadian data showed small improvement in DFS) has to be weighed ...