Questions discussed in this category
Which neo-adjuvant or peri-operative chemotherapy regimen would you choose? NCCN guidelines recommend FLOT or FOLFOX in the peri-operative setting vs....
Post-treatment PET/CT and MRI Pelvis at 3 months showed near resolution of iliac and inguinal lymphadenopathy but new avid retroperitoneal lymph nodes...
Or do you consider SBRT for any size lesion as long as the dose constraints for normal liver are met?
Colloid is a rare histologic subtype and considered to have more favorable outcomes compared with usual ductal adenocarcinoma, but no dedicated prospe...
What do you recommend if the patient would need an APR because of anal sphincter involvement and/or would like to attempt non-operative management?
Do you recommend chemoradiation with 5-FU and MMC or other agent? Does your elective nodal coverage change compared to typical squamous cell carcinoma...
If so, what clinicopathologic features would indicate consideration of radiation therapy?
RAPIDO and Myerson paper don’t mention any and it looks like T4 patients were treated, presumably covering external iliacs which would likely ha...
Would you use platinum/etoposide concurrent with radiation or would you opt for platinum only during radiation?
Would you use BID fractionation...
If no preop chemo was added, would you consider adj CRT? ARTIST2 interim results presented in 2019 does not seem to support chemoradiation, although i...
Does extension to the anus affect your determination of T classification? Would you consider this a T2 tumor if it does not extend to the external sph...
If so, for how long?
Would you recommend radiation, systemic therapy alone, or chemoRT? What about if this recurrence occurred during or shortly after completion of adjuva...
Does your answer change for long course chemoradiation vs short course radiation therapy?
Is there a subset of patients you would avoid neoadjuvant CRT and operate first?
The invasive component had depth of invasion 1.7 mm, horizontal extent 3.5 mm.
This patient had a Ki67 of 27%. However, the inclusion criteria for the NETTER-1 Trial was Ki67<20%. Would Lutathera be an option if labs are withi...
Is there a role for re-irradiation? What cumulative dose constraints do you use for re-irradiation to the central hepatobiliary tract?
Does your recommendation for radiation therapy and/or radiation planning change?
If workup is negative for a primary lesion, would you consider prophylaxis of potential primary sites (anus/vulva?), and would you treat bilateral ing...
Considering a T2+ and/or N+ GE junction adeno, do you use neoadjuvant chemoradiation therapy or perioperative chemotherapy?
Does your treatment...
Assuming all other factors are favorable (pT1-2, TME, negative margins).
Is there a threshold of when you would use chemo/radiation?
Would you have reservations in treating patients with breast, GI, or pelvic malignancies with radiation alone or concurrent chemoradiation?
For example, in an upper or mid-esophageal cancer with a PET positive lesser gastric curvature node. Is it reasonable to treat PET positive areas only...
The CTV examples in the contouring guideline by Wu et al (https://www.ncbi.nlm.nih.gov/pubmed/26104943) don't appear to crop the CTV out of lung. Woul...
If there was no further resection and the initial LAR showed a pT4a (visceral peritoneum), pN1 pelvic nodal disease with positive radial margins, woul...
If you are treating a patient with liver SBRT, would you not treat a patient who cannot have fiducials? If you are treating without fiducials, are you...
Would you cover elective lymph nodes?
ASTRO 2015 esophagus guidelines recommended the abdominal para-aortic nodes to be included in the CTV whereas ARS 2020 guidelines did not. Instead, AR...
Would you reduce dose, e.g. from 30 Gy in 10 fractions to 20 Gy in 5 fractions, or hyperfractionate, e.g. 1.5 Gy bid to 20-30 Gy?
What strategies do you use to meet those constraints?
Would your recommendation change based on the patient's age, performance status, comorbidities, or chemotherapy details?
Would your management change if the prostate and lymph nodes were treated with radiation two years ago?
Would you be confortable to give full dose CRT?
If so what is the crietria?
Aquaphor, barrier cream, sitz baths, domboro, silvadene, foam dressings?
ASTRO 2019 guidelines conditionally recommends elective nodal RT in unresectable pancreatic cancer. However, NCCN states that ELNI is controversial in...
For example, would you give SBRT for HCC with concurrent liver abscesses or short course radiation therapy for a perforated rectal adenocarcinoma with...
What is the risk of perforation / fistulization?
What method provides the best reproducibility? Abdominal compression? Inhale breath hold? Exhale breath hold?
The concern being that if patient does not go to surgery, you have delivered lower BED with 36/15.
Liver SBRT maintaining 700 ccs of liver <15 Gy is a commonly used constrain; however, if the total liver volume is limited due to cirrhosis, prior ...
Does nodal positivity at time of surgery affect your decision?
How do you counsel patients on the benefit of adjuvant therapy who thought surgical resection was curative?
Should concurrent chemotherapy be given? How would you modify the regimen in elderly/frail patients?
In a patient with a large primary and a negative PET/CT for nodal disease, would you push for EUS for radiation planning? Or would this be an unnecess...
In a patient who has undergone resection and adjuvant chemotherapy who then recurs locally, how would you recommend treating? Would you treat ju...
If so, what dose-fractionation regimen do you utilize? What are your target volumes? Would you first recommend induction chemotherapy followed by rest...
What are you typical treatment volumes and doses for R0 vs R1 resections?
What dose, fractionation and what elective coverage do you recommend?
The NCCN guidelines categorically recommend adjuvant XRT for a cT1-2N0 rectal adenocarcinoma upstaged to a pT3N0, yet there are multipl...
If you would elect for adjuvant therapy, which study helps guide your choice of regimen?
Does the amount of time from 1st treatment change your management or thinking in this situation?
Do you electively treat nodes and how does your approach change with intra- or extra-hepatic primaries?
Would preop RT still be the treatment option for these kind of patients? Assuming that the rectovaginal fistula was from tumor progression.
Is it possible or common for patients to have mucosal telangiectasias along the portions of the GI tract in the radiation fields? If present, would yo...
Would you go to a higher dose for the primary and/or nodal volumes?
If the medical oncologist does not feel comfortable giving cisplatin or mitomycin...
Do your constraints change when treating standard fields for T3 disease versus including external iliac lymph nodes for T4 disease when treating with ...
The patient went straight to gastrectomy for clinical T1 gastric adenocarcinoma, but post-op was up-graded to T4 disease.
Both ARTIST and Inte...
How would you adjust your small bowel dose constraints? What other considerations would be pertinent?
Plan to give adjuvant chemotherapy.
What-dose fractionation would you utilize? What small bowel constraints would you optimally set to achieve? How would your approach differ in a surgic...
Do you consider Macdonald type sandwich treatment 45Gy with xeloda?
Would you dose escalate gross node?
Would you treat stomach remnant and regional...
The recurrence is several adjacent nodes above the prior fields.
If biopsies consistently show high grade adenoma and there is a locally advanced rectal tumor with MRF involvement on imaging, what is the next step i...
For example, status post resection of a 4 cm high rectal carcinoma that was believed to be in the sigmoid colon but found interoperatively to be below...
I can't convince the surgeons to refer their patients for adjuvant RT because the prospective data is messy and doesn’t seem to indicate a benef...
Do you include external iliac nodes as for T4b (adjacent [anterior] organ invasion) or do you maintain the same coverage you use for T3 disease with a...
What dose would you use? How do you counsel on risk of damage to j-pouch?
Would your answer change in the postop setting for a tumor right above peritoneal reflection with positive pelvic nodes?
If the patient is medically inoperable, is post-chemotherapy radiation therapy or SBRT advisable with no visible GTV?
What constraints would you use for a 15 fraction regimen or other ablative regimen?
How long is too long to resume SBRT, and would you increase doses? Is there a number of elapsed days that would cause you to abort completion of SBRT?
Would your recommendation change if the patient had prior radiation proctitis and cystitis (now resolved)? Previous treatment records limited, but pre...
Does it improve patient quality-of-life?
The upfront plan is to use a definitive radiation dose of 66 Gy. My reading supports the use of 5FU + cisplatin but another doctor is recommending FOL...
Is diverticulosis in large bowel adjacent to a target a contraindication for SBRT? How would you manage?
Would you omit radiation therapy for some patients with Li-Fraumeni syndrome who would normally receive it?
MRI? Endoscopy? Physical exam?
Is there evidence for radiation therapy in this setting?
Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT? What if the size is >5 cm?
Should these patients be managed with high dose chemoradiation similar to the Danish study (Lancet in July 2015)? To what dose would you take the prim...
The CRITICS trial showed there was no OS or PFS benefit with adj chemo vs CRT. Is there potentially still a role for CRT to reduce heme toxicity and p...
Would you offer definitive or neo-adjuvant chemo-RT in the setting of a single lung or bone metastasis?
What is the duodenal stump dose constraint?
In which clinical situations is there a good rationale for the use of proton therapy for GI cancers?
Should we give concurrent capecitabine?
Higher radiation dose was shown to be associated with longer survival in Tao et al., JCO 2016. What dose constraints do you use when using these ...
Would you consider the addition of chemotherapy to proton beam therapy?
Are you doing more TNT to prolong time to surgery? If so, do are you starting with CRT or chemotherapy?
Would you be concerned with more and higher grade hepatobiliary toxicity with concurrent use of checkpoint inhibitors (i.e. Keytruda)?
When using short course RT, the NCCN guidelines currently recommend short course RT followed by chemotherapy, followed by surgery. Many surgeons are h...
What is your preferred combination and order of therapy for a T4 rectal tumor invading the uterus leading to both rectal and vaginal bleeding?
...
What dose and volumes of radiation would you use?
For those that tend to contour rather than set fields based on bony anatomy, how do you draw your CTVs?
Is there such thing a definitive radiotherapy in this setting, or would this be a purely palliative approach? If you would treat, what would your targ...
If so, what dose-fractionation regimen do you utilize? What are your target volumes?
In the case of multiple skip lesions in the thoracic esophagus and GE junction, the PTV may encompass nearly the entire esophagus, including the supra...
Would your recommendations change if you were treating a GI primary (e.g. rectal or anal cancer) vs non-GI primary?
Do factors such as large tumor size and/or node positivity affect the decision?
If so, what dose fractionation do you prefer?
How do you prevent early menopause in women? Please comment on freezing of eggs, oophopexy, supine vs prone position, vaginal dialator.
When indicated as in the setting of positive margins and/or positive lymph nodes, do you use V45 <195cc (QUANTEC), or V45 <15% (RTOG 0848), and ...
What factors do you use in deciding whether or not to electively cover the celiac axis?
*What dose and fractionation do you recommend for metastases >4cm in favorable positions (ie. not abutting mucosal tissue)?
Total neoadjuvant therapy consisted of with FOLFOX and chemoradiation therapy with Xeloda and 50.4 Gy.
Would you deliver a boost to the area and if s...
Any adjustments in terms of elective nodal coverage?
For a patient with an access to proton beam therapy, what dose regimen would you use in the context of a locally recurrent esophageal cancer, previous...
Is neoadjuvant chemoradiation or perioperative chemotherapy preferred?
What dose/fractionation do you use and what elective nodal areas do you cover? What studies do you order to aide in treatment planning (PET/CT? MRI?) ...
If you were to treat, what do you include in your treatment?
The German trial included patients with tumors up to 16cm from the anal verge, while the Swedish trial update found no local control benefit for tumor...
NCCN allows a range from 5.4-9 Gy for adjuvant boost and German trial used 55.8 Gy.
What factors might sway you to give a higher / lower dose? Is mor...
If so, what dose do you boost these nodes to?
Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...
Would your recommendation change with the following aggressive features: 8 cm, pericolic extension, positive radial margin, perineural invasion presen...
Would you be concerned about toxicity given that he has ulcerative colitis?
Would you alter your SBRT dose? How long would you hold the VEGF inhibitor before and after? Does the primary matter (e.g. NSCLC vs. colorectal)?
The NCCN seems to make its recommendation based on extrapolation from colon cancer, but those patients are not treated with pre-op chemoRT.
Would you treat with definitive doses?
If the patient will be having a total colectomy, would up-front surgery be a better consideration?
Would your answer depend on the response of the primary site?
Is there a role for additional treatment?
Would you offer local therapy to the liver?
Do you include the whole seminal vesicles and prostate, or just the whole seminal vesicles? Do you add external iliac lymph node coverage in this scen...
Further surgery is not possible.
The patient refuses surgery.
Do you worry about migration or scatter dose from the metal?
If so, what dose and fractionation?
Given this rare histology, would you treat this patient as a skin cancer or as an anal adenocarcinoma with inguinal nodal coverage?
Is this practice still relevant to the modern IMRT approach where skin toxicity is much lower?
Would you consider "neoadjuvant" RT to 45-50.4 Gy followed by a resimulation and a boost to a "definitive" dose of 54+ Gy depending upon disease respo...
What are the targets (tumor bed, positive margin, nodes etc.)?
Assuming good liver function currently, without evidence for recurrent cirrhosis?
Would your decision be affected if it was a primary HCC vs Liver me...
Or should total neoadjuvant therapy be reserved for bulkier disease (T4N2)?
I understand the perioperative trials are not based on tumor regression in cancer cells.
Do you recommend definitive therapy? Would your approach change if there are more than 1 site of bone metastases, such as 2-3?
Is there any data to support delayed treatment?
For instance, in borderline cases for neoadjuvant therapy (e.g. T2N1 disease), should both be obtained to increase accuracy?
What dose would you recommend? Any role for systemtic therapy?
Do you have any specific bowel constraints when treating patients with palliative radiation 3000/10?
Do you look at max dose or are there specific volumetric constraints you use for the small or large bowel?
Do you boost the positive nodes beyond your standard pelvic dose?
Our hospital has an aggressive and talented interventional radiology group. We have wanted to start a stereotactic liver radiotherapy program but are ...
What dose do you take the primary to?
Do you have any preferred dose fractionation schedules? What kind of margins do you use?
If so, how would you approach your radiotherapeutic plan and what dose-fractionation would you utilize?
This will influence the decision to operate or not, so you want to give it enough time to see a response, but given that it's a disease predisposed to...
Would you consider a re-biopsy after chemoRT to confirm viable tumor and if so, how long would you wait after chemoRT before biopsy? If you did ...
If so, what would your target encompass?
Colonoscopy reveals inflammation in the colon and rectum due to Crohn's and patient also has perianal fistula due to Crohn's.
Do you use concurrent Xeloda?
What percentage of unresectable T4N0 pancreatic body adenocarcinomas with celiac axis involvement and no response to 6c chemo, will convert to resecta...
For the first treatment day (during combined chemo/XRT courses), is it ok to give XRT first then send the patient for chemo or should the chemo be giv...
I am currently managing two patients (one esophageal and one anal) with this scenario and the referring physicians and patients are reluctant to under...
The data is scarce- do you recommend chemotherapy only or would you consider RT for local control?
Is there a role for SBRT with or without the addition of systemic therapy?
As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula?
Currently we would recommend esophagea...
Does this vary depending on the site you are treating, i.e. abdomen vs pelvis?
Would you recommend neoadjuvant chemotherapy to spare the stomach?
What pathologic factors would you use to make your recommendation?
If considering that it is not gastroesophageal junction, what margin do you place on the clipped GTV to formulate CTV? Is there any role for SIB to PE...
There is no RTOG consensus on boost volume, except to say that it should include the entire mesorectum/presacral region at involved levels + 2 cm in c...
If so, what dose and dose constraints would you consider? How would you counsel the patient about risk of trachesophageal fistula?
Is it sufficient to use fluoroscopy to assess total motion, fuse MRI and PET to create an ITV, and use abdominal compression to limit motion?
What features would make you more likely to recommend radiation therapy with chemotherapy?
The patient has no evidence of lymph node involvement.
If you would recommend radiation therapy, what dose-fractionation would you utilize?
Detailed instructions regarding lymph node coverage have been published, but how do you think about coverage of the anastamoses from the gastrectomy?
What timing do you recommend? What drug and what dose do you use?
Anal cancer guidelines mostly refer to anal canal tumors with less information about tumors of skin in perianal area (ie true anal margin).
Would IMR...
What volumes and doses of radiation would you recommend? To what dose would you limit the rectum, especially in a patient with no salvage surgical opt...
Do you consider diversion colostomy, or abdominoperineal resection up front?
What are your thoughts on dose, avoidance structures, re-tx risk, etc?
Should the recent publication of Chen et al. dose escalation study for inoperable SCC esophageal cancer patients treated with CCRT, showing an 8% 5-ye...
In view of higher risks of rectal cancer after pelvic radiation, is more frequent screening warranted?
Does the lack of D2 dissection automatically necessitate adjuvant chemoradiation therapy (ie <5 LN obtained)? Would the presence of high risk facto...
For a patient with cT3-4N0 rectal cancer, does the dose of the previous RT affect your decision making (for example, 45 Gy to the pelvis with boo...
What chemotherapy and radiation doses/fractionation would you use once the airway has been stabilized to provide reasonably safe and effective palliat...
Do you consider palliative SBRT 25Gy in 5 fractions? I often find that these patients are in severe pain and my typical regimen is 30 Gy in 10 fractio...
What are your fields? Do you treat nodes electively?
What doses do you use?
How often do patients become unable to tolerate the dilator during the treatment course secondary to discomfort related to acute toxicity?
What radiation doses would you use? Would the radiation dose and fields be the same as for squamous cell carcinoma? What chemotherapy would you recomm...
The CROSS trial showed a survival benefit with 4140cGy and concurrent carbo/taxol, but I was always trained to treat to 5040cGy. Is anyone de-escalati...
On the heels of the discussions regarding skin toxicity prophylaxis and treatment, I am interested in your thoughts and current practice regarding pat...
Do you have different preferences based on T-stage?
What would be your preferred management, surgical resection or radiation? If radiation is contemplated, what dose would be appropriate and would HPV s...
What features would help you decide between TACE vs. TARE vs. external beam radiation therapy?
In particular, many guidelines suggest a max point dose of 50Gy for small bowel but in cases of extensive disease how do you reconcile loops of bowel ...
Is there a risk for anejaculation?
Based on the UK OnCoRe matched cohort analysis, would you offer a watch-and-wait approach off protocol or are you uncomfortable treatin...
Would you consider repeating neoadjuvant chemo/RT? Does this, occurring in the context of Lynch Syndrome, change the treatment approach?
If the oropharyngeal cancer is operable (ex T1N1), would would your preference be upfront surgery?
Would you use chemoradiation therapy to bo...
Would you recommend only chemotherapy or would you offer chemotherapy followed by restaging and possible definitive CRT and surgery?
Are the treatment volumes the same as those for squamous cell carcinoma of the anal canal?
Given risk of secondary malignancies do you make an effort to avoid/spare the prostate or give any specific dose constraints when treating young men w...
Is this patient considered to have metastatic disease? Should definitive surgery be considered?
Are these patients better candidates for preop chemotherapy alone?
Will you treat only the anastamosis and remnant stomach without elective nodal RT, or will you include elective nodal RT in your treatment fields, ass...
If a patient is unable or unwillling to undergo dual or tri-modality therapy with chemotherapy or surgery, would you use a palliative radiation treatm...
Apart from H&N SCC, are there times where adding an extra dose of radiation due to a tx break is appropriate? Is there a decent equatio...
If so, how do you quantify this when making a decision about who may or may not be a candidate for SBRT?
If treating the H&N first, would you anticipate some effect of chemo on the rectal cancer? Would you include 5FU in the H&N chemo for be...
What fractionation would you use?
If the patient has large, bulky nodes would you consider starting after chemotherapy for cytoreduction? Or otherwise consider replanning mid-treatment...
Would you recommend chemoradiation therapy or chemotherapy upfront?
Any role for surgery? What radiation volumes would be used?
5FU/mitomycin C or 5FU/cisplatin? Is there any benefit of cisplatin in terms of skin toxicity?
Do you recommend 5FU/mitomycin chemoradiotherapy or radiotherapy alone?
What evidence is there for efficacy and toxicity differences between the two ...
Is there any evidence to show that treating with a bellyboard is preferred?
What dose and volumes would you use?
If the patient received neoadjuvant FOLFOX for 4 cycles then 50.4 Gy with concurrent capecitabine, is that enough treatment to omit surgery?
Is curative intent surgery off the table?
Surgery showed 1/5 and 1/4 LNs involved in the groins. What areas would you cover and with what corresponding doses?
What if the patient was not a candidate for additional chemotherapy? Would your answer change if the patient received the CROSS regimen with <...
Is the approach chemoradiotherapy (Mitomycin-5FU) as for squamous carcinoma with surgery only for salvage or do you always perform surgery after neo-a...
Is there a risk of increased sphincter tone issues in these patients?
Is there a benefit of SBRT over Y90 or vice versa?
Is obtaining serial MRIs or other imaging appropriate?
If so, what regimen would you consider?
In a patient who received upfront surgery and chemotherapy who later recurred in the regional nodes, s/p lymphadenectomy, would you offer RT? If...
Is concurrent chemoradiation reasonable or excessive in a patient with life expectancy <5 yrs? Should the standard be 5 Gy x 5, and will this provi...
Does it ever differ from a standard rectal field? For example, do you always treat the entire rectum, mesorectum, and entire length of internal iliac ...
Antacids? Anti-motlity agents? Dietary changes? Combination?
How do you deliver it safely? Even when there is adherence to other organs (T4) or positive margins, I'm hesitant to offer RT because the volumes are ...
Do you factor in the time interval when deciding cumulative dose constraints?
For example, a patient with cervical or anal SCC who has missed many treatments due to side effects, low blood counts, hospitalizations, or non-compli...
A nuimber of options for treatment but not a lot of great data for this rare disease.
The RTOG contouring atlas doesn't give a consensus on this issue.
Would you send the patient for a stent or do palliative RT?
http://ascopubs.org/doi/full/10.1200/JCO.2015.64.2710
What would be the RT dose and what percentages would you quote for toxicities? Would you recommend consideration of surgery instead?
Fecal incontinence can be one indication. What are others?
Should radiation be offered as a bridge to transplant? Should this depend on whether SBRT is feasible (i.e. is fractionated IMRT an appropriate option...
Given lack of strong evidence supporting the benefits of adjvuant RT in resected pancreatic adenocarcinoma (with results of the ongoing RTOG 0848 unav...
If so, what constraints would you use for central biliary and other normal structures and what dose/fractionation would you use?
Would you treat the node alone, unilateral/bilateral inguinal nodal basins, or cover any possible primary locations such as the anal mucosa?
Is better systemic control needed to make radiation therapy beneficial?
Do you use the same constraints that you would for the rectum? Or perhaps employ a lower dose limit, such as not exceeding 65Gy to a small volume of t...
What about bulky nodal disease?
Does your management differ if the hiccups are felt to be related to chemotherapy as opposed to the disease itself?
Have you ever seen toxicity related to diaphragm dose with conventional fractionation?
In what situation, if ever, do you include mediastinal nodes?
Is there a preferred method and should any of the following be avoided: esophageal stent, nasogastric tube, PEG, J-tube, or TPN?
Do you assume some recovery since the prior course of RT? If so, how much over what time period?
In LAP07's second randomization (capecitabine+54 Gy vs maintenance gemcitabine +/- erlotinib), 60% of unresectable pancreatic cancer patients who did ...
RTOG 0529 guidelines were 2.5cm margin from GTVA to CTVA (except bone or air), do you still follow this practice?
If a patient developed locoregional recurrence after initial chemoradiation, would resection of known disease followed by observation be preferred?
Is inguinal coverage always required?
How would the new data presented at ASCO GI 2021 from from Alliance A021501 influence your answer?
Specifically, are hilar nodes metastatic?
Does treatment of the pancreas with radiotherapy during an episode of acute pancreatitis increase the risk of acute and late side effects? Should one ...
At other sites we consider locally advanced disease and high risk of recurrence a contraindication for organ preservation. Would surgery improve likel...
Per NCCN, only well-differentiated T1 lesions (with 1cm surgical margins) should be excised (with no other treatment). Do you follow this at your inst...
For example, there is a retrospective series out of MD Anderson (Kim, Acta Oncologica 2008) wherein 37 patients with gastric cancer were treated with ...
Will higher doses per fraction increase the risk of fibrosis and cause permanent impediment to biliary flow?
Would your recommendation change if the histology was adenocarcinoma (excluding GE junction tumors)?
Reference: https://www.ncbi.nlm.nih.gov/pubmed/23578724
For example, would you use a cutoff such as PTV of 25cc, or 4cm diameter, or simply use nearby normal tissue constraints to alter your fractionation f...
Is your approach similar in unresectable disease? Is there evidence to support one approach over the other?
Is MRI being considered the primary mode of imaging in multidisciplinary tumor boards, especially in light of the results of the MERCURY trial (JCO 20...
What if a large portion of small bowel is located within PTV45?
Would taking the drug at a specific time point prior to their radiation appointment time to maximize blood levels of the drug be clinically beneficial...
The Stanford report (Osmundson, IJROBP 2015) on central hepatobiliary tract toxicity recommended dose constraints to the cHBT that would limit dose to...
How would your radiation treatment approach change in terms of dose and target definition?
Would the time interval between diagnosis affect the optio...
Do you target the whole pelvis or a smaller "boost-like" field?
In a patient who is not a surgical candidate and has a negative PET/CT and EUS, would you include celiac lymph nodes in the radiation field?
Specifically - anus, pancreas, gastric?
Do you use any age limit to determine whether pancreatic SBRT is appropriate?
How do you manage a patient a with a PET positive inguinal lymph node who has a typical anal cancer? If a biopsy is done and it is negative, is it is ...
In a case with negative margins, would you consider chemotherapy alone or sequence with chemoradiation?
Does the presense of ulcerative colitis, now in remission, affect your dose and fields?
When planning SBRT cases for primary liver cancers, it is very difficult to see the tumor on the non-contrast 4D scan. How do you use information from...
In my training, we used an abdominal compression paddle, but in my current practice, my physicist says that we cannot treat through multiple parts of ...
Are there any precautions to prevent formation of a TE fistula?
Would your approach change if the histology were adenocarcinoma?
In a lesion <2.5 cm from anal verge arising in a tubulovillous adenoma, does the data from Taylor, et. al. Red Journal 2001 apply?
Would you avoid any RT in these patients, including palliation for a portal vein thrombus? Or would you consider a short course of RT (like 20Gy/5fx)?
In a patient with an R0 resection, would you routinely recommend postop chemoradiation, since these patients were included in the MacDo...
For cases with positive margins, do you boost to 54 Gy? If so, do you boost the entire tumor bed or only the area of the positive margin?
Should standard post operative radiation fields be used, treating up to the L5-S1 interspace? Or is it acceptable to treat a lower field, for ins...
If RT/chemo is preferred, what is an acceptable final boost dose?
Fore example for a T3N0 rectal cancer on EUS?
Would you boost to >54Gy? 60Gy? Is there relevant literature/evidence for supporting a higher dose?
In the past, I haven't seen great results in palliating the presacral area. The pain is excruciating for many patients. Is there an effective option f...
I.e. Would you treat most of the normal esophagus to include a mediastinal lymph node?
While the Nigro/Wayne state regimen consisting of Mito C & 5FU is well stablished for squamous cell carcinoma of the anus/perianal tissue, a...
If so, what dose?
What regional lymph nodes do you include perigastric, portahepatic, periesophageal, celiac, splenic, pancreaticoduodenal, sup. mesenteric, paraesophag...
Are there any indications to choose one over the other?
How should we counsel young women who are receiving treatment for GI/GYN malignancies?
I have a healthy 70+ year old man recently diagnosed with cT3N1M0 rectal adenoCA and GS 3+4=7 prostate cancer in 1/6 cores with a PSA of 25.
Is ...
Is there a consensus on the MAGIC v. MacDonald debate?
I recently had a patient with unresectable disease ask for a PET before starting RT but I’m not sure there is a benefit.
We use PET for esophageal, but not gastric cancer. GE junction seems like a grey area.
Does the advent of FLOT in gastric cancers, change your approach to GE adeno's? Would anyone consider FLOT followed by chemoradition followed by surge...
What techniques work best?
Papers discussed in this category
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Lancet Oncol., 2015-09-01
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Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-07-20
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-07-20
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Ann Surg, 2007 Nov
N Engl J Med, 2006 Jul 6
The New England journal of medicine, 2001-09-06
BMC Cancer, 2015-07-21
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Practical radiation oncology, 2012
Urology, 1999-10
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Int J Colorectal Dis, 2012-11-01
International journal of radiation oncology, biology, physics, 2001-11-01
Radiat Oncol, 2014-12-23
Lancet (London, England), 2009-03-07
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Br J Surg, 2006-10-01
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-11-01
International journal of radiation oncology, biology, physics, 2014-03-15
Ann. Surg. Oncol., 2017 May 30
Ann. Oncol., 2019 Jun 13
Ann. Surg., 2007-11-01
Int. J. Radiat. Oncol. Biol. Phys., 2008-02-01
Cancer, 1983-05-15
Cancer, 2010-02-15
International journal of radiation oncology, biology, physics, 2013-05-01
International journal of radiation oncology, biology, physics, 2007-02-01
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2004-08-15
Journal of cancer research and therapeutics, 2011
Cancer, 2015-04-01
JAMA, 2012 Jul 11
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