Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are reasonable SBRT dose constraints for the lumbosacral plexus?
There are published dose tolerance guidelines for the sacral plexus with the AAPM TG101 report Benedict et al. Med. Phys 37(8): 4078-4101, 2010. Realize these have not been validatedOn page 4086, there is a table with suggested dose constraints for a 3 fraction regimen that include a threshold dose ...
How would you approach a laryngeal adenoid cystic carcinoma in a patient seeking larynx preservation?
This is a rare case scenario (laryngeal ACC) in a rare cancer (ACC) of an uncommon group of malignancies (primary salivary gland malignancies) for which direct evidence is sparse. I would, therefore, approach with some general principles and a generous pinch of salt in this scenario. The initial tre...
Do you offer vaginal cuff brachy alone, vaginal cuff brachy and chemo, or WPRT for surgically staged IB grade 3 endometrial cancer?
All patients who have stage IBG3 fall into the GOG249 eligibility criteria. However, it is important to recognize that patients within this group have broadly varying risks. First of all, serous cancers (which have a greater propensity to spread intraperitoneally and may demand variant-specific appr...
What normal tissue constraints do you use when treating a palliative head and neck patient with the Quad Shot?
Great practical question. The constraint mentioned in the question is only for 8 fractions and the goal is to get the patient to all 12. Keep in mind that most of the published series used 3D technique with IMRT being used in the tail end of the patient series. I have used BED calculations to conve...
What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?
My approach has been: Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they re...
How do you approach treatment planning for lung SBRT in a patient with a lesion within 1 cm of a defibrillator?
V-fib requiring defibrillation poses an immediate life-threatening situation. Even if the patient doesn't regularly need their pacemaker, one would need to know that their defibrillator is functioning. In this case, I don't think there's any choice except to move the pacemaker/defibrillator to the o...
Do the MA.20 and EORTC 22922 studies, showing no survival advantage from regional nodal irradiation in early-stage breast cancer patient following surgery, change your standard of care for these patients?
Two major landmark studies recently published simultaneously in the New England Journal of Medicine, Volume 373, 2015 (NCIC MA.20 study by Whelan et al. and the European Organization for Research and Treatment of Cancer (EORTC) 22922-10925 study by Poortmans et al.) will have a significant impact on...
Under what circumstances would you offer PMRT in a patient with DCIS?
I favor in the setting of multiple positive margins, especially for high-grade DCIS.
For those treating osteoarthritis with LDRT, is there any concern of adverse effects or decreased efficacy in patients with osteoporosis?
I’m not aware of any data specifically looking at the efficacy of LDRT for OA in patients with osteoporosis. The anti-inflammatory mechanism of LDRT should not be altered by the bone thickness/quality, but repetitive “injury” contributing to OA may be different if the cause is related to bone qualit...
Do you use specific scalp dosimetry constraints to prevent chronic alopecia when treating partial brain volumes with VMAT?
I have been using VMAT for 8 years to treat brain tumors, and permanent alopecia is rarely a complication in patients treated with doses of >50 Gy. For that reason, I personally do not use a scalp OAR constraint when planning a course of partial brain radiation. Prior to the adoption of VMAT, the oc...