Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In what circumstances would you offer axillary re-irradiation after salvage axillary dissection?
A study from many years ago found no further axillary recurrences in 4 patients who had gross total excision of axillary recurrences following initial breast-conserving therapy, including RT and axillary dissection, with a median follow-up of 28 months (Recht et al., PMID 2033433). However, there is...
Do you routinely offer PMRT for T3N0 breast cancer?
Yes, especially in young women. The Danish PMRT trial included T3N0 patients, and in the pre-menopausal group, there was a meaningful increase in overall survival (10-year actuarial survival 82% vs 70%, with vs without PMRT; Overgaard et al., PMID 9395428). Now, one can argue that this is an old ...
Is there data to support treating postoperative endometrial pelvic EBRT with a daily dilator in the vaginal canal?
Data is more for GI malignancies on using a vaginal dilator to reduce dose to the anterior vaginal wall and thus the risk of stenosis. With the vagina being a target for endometrial cancer, there is no study using it during RT to show any benefit.Arzola et al., PMID 37898354
What are some considerations for planning T&O brachytherapy in a patient with bilateral hip replacements, where it is difficult to delineate disease on MRI and even surrounding structures on CT?
I have favored MRI-based contouring and planning in these patients. Dual-energy CT or simulation metal artifact reduction software can also help with better delineation and planning.
When discussing definitive prostate radiation, how do you respond to patients who mention that they heard that surgery is more difficult after radiation treatment?
I love this question! I hear it quite often, and it provides an opportunity to discuss the differences between radiation and prostatectomy, and the potential benefits and risks of both. I start by stating that it is absolutely true that radiation causes scar tissue that can make surgery months to y...
In pediatric patients with Hodgkin lymphoma who have a partial response after chemotherapy and multiple disease sites above and below the diaphragm, how do you approach radiotherapy planning considering cumulative dose and toxicity?
RT dose and target volume in pediatric Hodgkin lymphoma are determined according to the systemic therapy protocol being used. For example, your case suggests a patient with Stage III or IV disease. In the COG study AHOD1331, patients received either Bv-AVE-PC or ABVE-PC systemic therapy x 5 cycles a...
What areas do you treat with RT for an intermediate or high risk pediatric Hodgkin Lymphoma with a slow early response?
For pediatric Hodgkin lymphoma, radiation fields are really based according to the treatment protocol. If the patient was being treated per AHOD 0031, then the radiation fields would include all sites of initial involvement, assuming they don't meet the criteria for omission of RT (RER and then a CR...
Does micropapillary subtype for a G1-2 DCIS affect your radiation treatment recommendations?
It doesn’t change the recommendation. If adequate, imaging and surgery are done, like any other DCIS.
Do you use liver SBRT to areas previously treated with Y90 and subsequently failed?
Prior Y90 is a risk factor for liver decompensation that's hard to quantify. If there is relatively low volume disease and I am retreating with complete overlap of the prior TARE, I don't think there isn't any increased risk with retreatment. If the TARE went to more than 1-2 segments, I would be co...
Does the presence of perineural invasion on a prostate biopsy change your management decision?
I would consider perineural invasion as one of the "soft" criteria that may help impact treatment decisions. Previously this would have also included such things as Gleason 3+4 vs. 4+3, Gleason 8 vs. 9-10, or the percentage of positive cores. However, as these factors have now been included in the A...