Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach oligoprogression of metastatic prostate cancer with a large met in the humeral head?
The role of radiotherapy for oligometastases is developing, with many studies underway. The best prospective data yet is for castration-sensitive oligometastatic prostate cancer, but there are several retrospective studies looking at the role of SABR for oligoprogressive CRPC. Two worth looking at a...
When treating a soft tissue sarcoma close to humeral head, what humeral head dose constraint should be used?
This is a fantastic question particularly in light of your absolutely correct assessment that the literature is silent on this issue. And osteonecrosis of the humeral head and humeral fractures have certainly been reported (e.g. Rossleigh et al (1986) Cancer); this coupled with a potential arthritis...
What planning and dose constraints are you using for 5-fraction hypofractionated FRST for vestibular schwannoma?
When using fractionated SRS (fSRT) of 25 Gy in 5 fractions for vestibular schwannomas, I use only 2 constraints: the brain stem and the cochlea, if the patient has serviceable hearing. In this case, the only OAR needed is the brain stem, 23 Gy <0.5 cc. I don't worry about the trigeminal nerve as it ...
What is your target volume for a recurrent low-grade meningioma previously treated with surgical resection alone?
This is a great practical question. What I have done is to fuse the original MRI, the pre-op recurrence scan and the post-op recurrence scan so that the clinical target volume can be all the meningeal surfaces that were ever in contact with the meningioma (initially or at progression). I don't usual...
Are there dosimetric scenarios where using a FFF beam would be beneficial in a non-modulated beam, like AP/PA or 3D conformal?
Except for less treatment time, the rest would all be less advantageous with FFF, as it takes more time to plan, and the dose is less uniform when using it for 3D conformal RT.
Is there evidence to support bladder preservation therapy in node positive bladder cancer?
Although there aren’t randomized data suggesting the superiority of trimodality therapy (TMT) over any other treatment for N+ bladder cancer, I think most feel that it is the standard of care as alluded to in the question. Broadly speaking, patients and providers have two options: radical therapy or...
When do you refer a patient with recurrent glioma for reoperation?
This question is a nuanced one that is dependent on many factors. When a patient has a recurrent glioma, the treatment options are generally re-resection, medical therapy (traditional chemotherapy or targeted agents, depending on the tumor), or radiation. Which treatment modality, or combination of ...
How would you treat a patient with UC and a J-pouch presenting with basaloid carcinoma of the prostate who is not a surgical candidate?
This is a difficult scenario. One way of approaching this is by considering SBRT to the prostate and seminal vesicles after placing a rectal spacer. The typical dose is 3,625 cGy in 5 fractions, given on alternate days. Ensuring there is no bowel (small or large) within proximity of the superior asp...
With the addition of pembrolizumab following chemoradiation per KEYNOTE-A18, would you be less likely to treat the paraaortic chain prophylactically?
I would favor the same volume of RT with or without pembro. If there is an indication to treat PA nodal chain, would treat as per plan.
How would you treat a patient with isolated CNS relapse of seminoma?
As one would expect there are really no reliable data to use to make decisions. I am assuming that there is no significant elevation of HCG or AFP? Typically, I would first recommend engagement of a high-volume center to review details of the case and get guidance. This is a highly unusual setting f...