Radiation Oncology

Gastrointestinal Cancers

Questions discussed in this category

How do you choose between SBRT and RFA for CRC metastases to the liver?

*What dose and fractionation do you recommend for metastases >4cm in favorable positions (ie. not abutting mucosal tissue)?

1 Answer available

Is there a role for a post-operative boost in a patient with rectal cancer who has a positive margin after total neoadjuvant chemo and chemoradiation therapy?

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...

1 Answer available

Would you treat rectal squamous cell carcinoma the same as rectal adenocarcinoma, stage for stage?

Any adjustments in terms of elective nodal coverage?

4 Answers available

What dose constraint do you use for the ostomy site when treating a patient with close/adjacent disease?

1 Answer available

What proton dose regimen would you use for locally recurrent esophageal cancer previously treated with chemoRT?

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...

3 Answers available

Would you offer adjuvant chemoRT for node positive high rectal cancer above the peritoneal reflection?

3 Answers available

How would you treat a patient with adenocarcinoma of the GE junction in the setting of interstitial lung disease?

Is neoadjuvant chemoradiation or perioperative chemotherapy preferred?

1 Answer available

How would you treat a T4 rectal cancer invading the uterus that is causing rectal and vaginal bleeding?

What is your preferred combination and order of therapy for a T4 rectal tumor invading the uterus leading to both rectal and vaginal bleeding? ...

1 Answer available

How do you treat duodenal adenocarcinoma when using primary chemoradiation therapy?

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?) ...

1 Answer available

Would you offer SBRT in a patient with history of CRC, subsequently found to have a solitary liver metastasis treated with chemotherapy followed metastasectomy with positive margins?

1 Answer available

For borderline resectable pancreas treated with induction chemo therapy and minimal radiographic response, if unable to do SBRT, do you prefer 36/15 or 50.4/28 (given that is where we have more data)?

The concern being that if patient does not go to surgery, you have delivered lower BED with 36/15.

1 Answer available

In what situations would you treat with adjuvant radiation for resected gallbladder cancer?

If you were to treat, what do you include in your treatment?

1 Answer available

Is there a role for dose escalation beyond 50.4 Gy in neoadjuvant chemoradiation therapy for rectal cancer?

1 Answer available

For a patient with a solitary kidney, what dose constraints would you use for SBRT to a nearby site?

2 Answers available

Do you treat rectosigmoid/upper rectal cancers with neoadjuvant chemoradiation?

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...

5 Answers available

What dose do you use for postoperative rectum boost?

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...

4 Answers available

Would you recommend chemoradiation to the pelvis for a patient with squamous cell carcinoma of the anus metastatic to the liver who has had a complete response to chemotherapy in the pelvis and a liver resection?

2 Answers available

In patients undergoing pre-operative chemoradiation for rectal adenocarcinoma with clinically positive pelvic sidewall nodes that may not be surgically accessible, do you boost these nodes above 50.4 Gy?

If so, what dose do you boost these nodes to?

1 Answer available

How do you sequence antiviral therapy and cancer-directed therapy in a newly diagnosed patient with hepatocellular carcinoma and incidentally found hepatitis C?

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...

1 Answer available

How would you manage a patient with T3N0 rectal cancer status post transanal excision, who is not a surgical candidate, and who received pelvic radiation for prostate cancer 20 years ago?

Would you be confortable to give full dose CRT?

1 Answer available

Is it common to have atypical squamous cells on pap smear s/p chemoradiation for anal cancer in a female?

1 Answer available

What radiation dose, fractionation and volume would you use in an elderly patient with localized extensive anorectal malignant melanoma status post laparoscopic APR?

Would your recommendation change with the following aggressive features: 8 cm, pericolic extension, positive radial margin, perineural invasion presen...

1 Answer available

How would you manage an elderly patient with GE junction adenocarcinoma who is not interested in surgery and who has ulcerative colitis (not currently on medication or symptomatic)?

Would you be concerned about toxicity given that he has ulcerative colitis?

1 Answer available

In rectal cancer in patients receiving total neoadjuvant therapy of FOLFOX followed by 5FU-radiation, is there a role for additional adjuvant chemotherapy based on significant residual disease at time of surgery?

1 Answer available

How would you approach potential SBRT to liver metastases in a patient on a VEGF inhibitor?

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)?

1 Answer available

For a patient with terminal ileal Crohns disease who requires chemoRT for distal rectal cancer, can mercaptopurine (6MP) be continued during that phase of treatment?

1 Answer available

Is there evidence to support routine use of adjuvant chemotherapy for resected rectal cancer treated with pre-operative chemoradiation?

The NCCN seems to make its recommendation based on extrapolation from colon cancer, but those patients are not treated with pre-op chemoRT.

3 Answers available

Do you offer definitive chemoradiation for a primary duodenal adenocarcinoma?

If so, what dose-fractionation regimen do you utilize? What are your target volumes? Would you first recommend induction chemotherapy followed by rest...

1 Answer available

Would you consider upfront chemoradiation therapy for a patient with metastatic anal squamous cell carcinoma if they have a large burden of disease at the anus?

Would you treat with definitive doses?

2 Answers available

If tumor is stradling the peritoneal reflection how do you decide whether to treat with neoadjuvant chemo/RT vs just surgery?

1 Answer available

Should neoadjuvant chemoradiation ever be considered in the a patient with high risk rectal cancer in the setting of active ulcerative colitis?

If the patient will be having a total colectomy, would up-front surgery be a better consideration?

1 Answer available

Is there a role for consolidative definitive radiation therapy for metastatic rectal adenocarcinoma with good response to systemic therapy (patient is not symptomatic)?

1 Answer available

In a patient with distal esophageal cancer with a single non-regional neck lymph node, would you offer chemoradiation therapy or surgery to the primary site if the lymph node has a complete radiographic response after chemotherapy?

Would your answer depend on the response of the primary site?

1 Answer available

How would you manage a patient who received neoadjuvant CRT per the CROSS trial for esophageal cancer, but refuses surgery after imaging shows a good radiographic response?

Is there a role for additional treatment?

2 Answers available

How would you manage a patient with oligometastatic colon cancer status post resection of the primary whose single unresectable liver lesion has had a complete response to FOLFOX chemotherapy by PET?

Would you offer local therapy to the liver?

1 Answer available

In patients with rectal cancer receiving neoadjuvant chemoradiation, how does possible seminal vesicle involvement on MRI affect the contours of your target?

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...

1 Answer available

How would you approach a small mucinous adenocarcinoma of the anal verge (without anal canal involvement) with positive margins after resection?

Further surgery is not possible.

2 Answers available

How would you manage a patient with Lynch syndrome who is s/p surgery and pelvic RT 20+ years ago for endometrial carcinoma with a new T3N0M0 squamous cell carcinoma of the anus?

The patient refuses surgery.

2 Answers available

Do you use a metal biliary stent as a fiducial marker for cholangiocarcinoma?

Do you worry about migration or scatter dose from the metal?

2 Answers available

What dose/fractionation would you choose for resected tail of pancreas adeno with positive margin, node negative?

Plan to give adjuvant chemotherapy.

1 Answer available

Would you consider chemoradiation to the primary in a patient with resectable pancreatic cancer s/p neoadjuvant chemotherapy found to have single liver metastasis on re-staging?

If so, what dose and fractionation?

1 Answer available

How would you approach a mucinous adenocarcinoma of the anal verge without anal canal involvement, status post excision with positive margins but without the possibility of additional surgery?

Given this rare histology, would you treat this patient as a skin cancer or as an anal adenocarcinoma with inguinal nodal coverage?

1 Answer available

Should anal cancer patients undergoing definitive chemoradiation be put on a treatment break for neutropenic status?

Is this practice still relevant to the modern IMRT approach where skin toxicity is much lower?

1 Answer available

Is there a role for pre-operative RT (+/-chemo) for a borderline resectable Klatskin tumor as an attempt to try to get them to surgery?

1 Answer available

How do you treat unresectable pancreatic adenocarcinoma invading into the duodenum?

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...

1 Answer available

What chemotherapy regimen do you recommend with radiation therapy for cervical esophageal squamous cell carcinoma?

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...

1 Answer available

What constraints do you use for the gallbladder when giving liver SBRT to lesions close to the gallbladder?

1 Answer available

How soon after ChemoRT for a head and neck cancer can you safely initiate esophageal dilation?

3 Answers available

When is SBRT or hypofractionated radiation appropriate as adjuvant treatment for pancreatic cancer?

What are the targets (tumor bed, positive margin, nodes etc.)?

4 Answers available

In what situations can short course RT (5Gy x 5fx) be used instead of chemoRT for rectal cancer?

6 Answers available

Do you recommend definitive chemoradiation for unresectable gastric adenocarcinoma in a medically unfit patient?

If so, what dose-fractionation regimen do you utilize? What are your target volumes?

2 Answers available

What is the appropriate radiation dose/volume for perianal basal cell carcinoma?

Should concurrent chemotherapy be given? How would you modify the regimen in elderly/frail patients?

1 Answer available

Would you offer liver SBRT to a patient with a history of a liver transplant?

Assuming good liver function currently, without evidence for recurrent cirrhosis? Would your decision be affected if it was a primary HCC vs Liver me...

1 Answer available

If a patient has distal esophageal adenocarcinoma and a PET+ left supraclavicular lymph node, and nothing in between, would you cover the entire esophagus? Both supraclavicular fields?

1 Answer available

What role, if any, is there for Y90 in metastatic gallbladder cancer to the liver?

1 Answer available

Can total neoadjuvant therapy be considered an option equivalent to standard of care treatment for patients with T3N0 or T3N1 rectal adenocarcinoma?

Or should total neoadjuvant therapy be reserved for bulkier disease (T4N2)?

2 Answers available

What adjuvant therapy do you give after surgery to patients with gastric CA who undergo 3 cycles of FLOT with no tumor effect on pathology and maintain good PS?

I understand the perioperative trials are not based on tumor regression in cancer cells.

5 Answers available

How do you approach rectal cancer with a solitary bone metastasis that is biopsy proven?

Do you recommend definitive therapy? Would your approach change if there are more than 1 site of bone metastases, such as 2-3?

1 Answer available

Do you recommend neoadjuvant radiation or chemoradiation for patients with T1-2 N0 adenocarcinoma of the anal canal prior to APR?

2 Answers available

What anal squamous cell carcinoma patients, if any, do you take to 59.4 Gy?

1 Answer available

What dose do you use for squamous cell carcinoma of the cervical esophagus?

2 Answers available

When treating node positive anal squamous cell carcinoma, dose your lymph node boost include only gross disease with margin or do you boost the entire nodal region?

1 Answer available

Would you still offer adjuvant chemoradiation therapy to a patient with pT3 pN1a rectal cancer who did not receive any neoadjuvant treatment, and whose adjuvant treatment is delayed by 4 months due to post-operative complications?

Is there any data to support delayed treatment?

1 Answer available

In what situations do you obtain both a pelvic MRI and EUS for rectal cancer staging and treatment planning?

For instance, in borderline cases for neoadjuvant therapy (e.g. T2N1 disease), should both be obtained to increase accuracy?

1 Answer available

Is it appropriate to treat unresectable secretory insulinoma of tail of the pancreas with radiation therapy?

What dose would you recommend? Any role for systemtic therapy?

1 Answer available

In a patient with gastric adenocarcinoma with +peritoneal cytology status post an R1 resection, would you consider post operative chemoradiation?

2 Answers available

Would you consider prone SBRT (with solid image guidance techniques) if bowel is lying on a target, for instance bowel surrounding an oligometastatic lymph node or next to a kidney tumor?

1 Answer available

Would you recommend adjuvant radiation therapy to a T4N0 colon cancer with invasion into other organs or the abdominal wall status post R1 resection?

Would you cover elective lymph nodes?

3 Answers available

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?

1 Answer available

In patients receiving neoadjuvant CRT for cN+ rectal cancer, do you expand your elective nodal volumes to include the external iliac chain or to extend more superiorly along the common iliac chain?

Do you boost the positive nodes beyond your standard pelvic dose?

4 Answers available

What is the role of liver SBRT in the setting of an excellent interventional radiology program?

Our hospital has an aggressive and talented interventional radiology group. We have wanted to start a stereotactic liver radiotherapy program but are ...

3 Answers available

When do you consider total neoadjuvant therapy (chemotherapy and chemoradiation) for rectal cancer?

1 Answer available

For gastric cancer receiving FLOT perioperatively with negative margins but multiple positive nodes, do you offer postoperative chemoRT?

1 Answer available

How do you manage an anal SCC status post a non-oncologic excision of a 2-3 cm primary and positive excisional biopsy of an inguinal node with pathology revealing LVSI, positive surgical margins, and more regional lymph nodes on PET?

What dose do you take the primary to?

1 Answer available

How do you decide what elective lymph node stations to include in your treatment volume for cervical and upper and middle thoracic esophagus cancer?

1 Answer available

In patients witih locally advanced pancreatic cancer, how long would you wait after 1st line induction chemotherapy with FOLFIRINOX before you image for assessment of response and deciding about 2nd-line therapy?

1 Answer available

What is your general approach to treating bleeding gastric masses with palliative RT?

Do you have any preferred dose fractionation schedules? What kind of margins do you use?

3 Answers available

Would you offer radiation therapy for pleural- or peritoneal-based pseudomyxoma peritonei?

If so, how would you approach your radiotherapeutic plan and what dose-fractionation would you utilize?

1 Answer available

Would you offer adjuvant chemoRT to a patient with pancreatic adenocarcinoma who underwent neoadjuvant therapy with FOLFIRINOX and SBRT but had a positive (neck) margin on resection and is now s/p adjuvant chemotherapy?

1 Answer available

Would you recommend SBRT for locally advanced pancreatic adenocarcinoma invading the stomach s/p multiple rounds of chemotherapy?

1 Answer available

In light of the 2015 ASTRO plenary session presentation about involved-field radiation vs elective nodal radiation therapy, are you including elective nodal fields (celiac, mediastinal, supraclavicular) in the treatment of locally advanced esophageal cancer?

1 Answer available

How long after pancreatic SBRT do you wait to re-image?

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...

1 Answer available

How would you approach a patient with locally recurrent esophageal carcinoma who is s/p previous chemoRT and refuses salvage surgery?

1 Answer available

Would you offer additional radiation therapy in a medically inoperable patient with rectal adenocarcinoma who has a persistently palpable tumor after definitive chemoradiation therapy?

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 ...

3 Answers available

When would you offer adjuvant RT after R0 resection for a distal esophageal adenocarcinoma?

If so, what would your target encompass?

1 Answer available

What dose-fractionation would you utilize when treating an elderly patient with local-only pancreatic cancer who is not eligible for systemic therapy or surgery?

1 Answer available

Would you recommend pre operative (chemo)radiotherapy for a patient with a T3 N0 low rectal cancer in a patient with active Crohn's disease?

Colonoscopy reveals inflammation in the colon and rectum due to Crohn's and patient also has perianal fistula due to Crohn's.

1 Answer available

Do you treat elective nodes in unresectable pancreas when treating with 15fx?

Do you use concurrent Xeloda?

1 Answer available

Is there any data comparing neoadjuvant pancreatic SBRT vs standard fractionation in terms of its ability to convert unresectable tumors to resectable tumors?

What percentage of unresectable T4N0 pancreatic body adenocarcinomas with celiac axis involvement and no response to 6c chemo, will convert to resecta...

1 Answer available

Do you use any dose constraints for the spleen while delivering abdominal radiation therapy?

1 Answer available

How do you time same-day chemotherapy and radiation for patients undergoing concurrent chemoRT?

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...

3 Answers available

Would you treat the supraclavicular nodes electively for a patient with esophageal adenocarcinoma originating in the mid-esophagus but extending above the carina?

2 Answers available

What is the most appropriate radiation dose and volume for elderly and/or frail patients with advanced SCC of the anal canal not receiving chemotherapy to attain durable local control?

5 Answers available

When a large malignant appearing GI mass is encountered on endoscopy but biopsies show dysplasia or carcinoma in situ, would you recommend additional biopsies or proceed with treatment for invasive cancer?

I am currently managing two patients (one esophageal and one anal) with this scenario and the referring physicians and patients are reluctant to under...

4 Answers available

Do you consider adjuvant radiation for low grade T1bN0 gallbladder adenocarcinoma with negative margins after oncologic resection?

The data is scarce- do you recommend chemotherapy only or would you consider RT for local control?

1 Answer available

How would you approach oligometastatic (solitary) recurrence with previously resected pancreatic adenocarcinoma and adjuvant chemotherapy with a prolonged disease-free interval?

Is there a role for SBRT with or without the addition of systemic therapy?

3 Answers available

How do you manage a patient who presents with a tracheoesophageal fistula from a lung or esophageal primary that is non-metastatic?

As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula? Currently we would recommend esophagea...

4 Answers available

What image guidance do you use when treating rectal and anal cancers?

3 Answers available

When using oral contrast for simulation, how much prior to simulation do you have patients drink the contrast?

Does this vary depending on the site you are treating, i.e. abdomen vs pelvis?

3 Answers available

What neoadjuvant approach is best for an adenocarcinma of the GE junction (arising in Barret's) with a large hiatal hernia?

Would you recommend neoadjuvant chemotherapy to spare the stomach?

1 Answer available

Would you recommend adjuvant chemoradiation after adjuvant chemotherapy for a patient with pancreatic adenocarcinoma s/p a whipple resection with negative margins?

What pathologic factors would you use to make your recommendation?

1 Answer available

Should definitive concurrent chemoRT be offered to patients with anal canal SCCa with common iliac nodal involvement (by definition M1 disease) without evidence for other distant disease?

2 Answers available

How would you treat a patient with locally and distant recurrent rectal cancer who has previously received chemoradiation but now presents with pain and bleeding from the site of local recurrence?

1 Answer available

How do you approach treatment planning for preoperative radiation therapy in gastric cancer?

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...

1 Answer available

When treating rectal cancer with conventional neoadjuvant chemoradiation (45 Gy to pelvis with boost to 50.4 Gy), what volume do you use for the boost?

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...

2 Answers available

In patients with oligometastatic disease, would you offer SBRT to a metastatic lymph node abutting the trachea and/or esophagus?

If so, what dose and dose constraints would you consider? How would you counsel the patient about risk of trachesophageal fistula?

1 Answer available

How do you create an ITV for liver SBRT (metastatic lesions) when you don't have a 4D-CT or fiducials?

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?

3 Answers available

In the case of a thoracic esophageal cancer that will require extensive volume coverage, >2/3 of the esophagus, do you prophalactically prescribe a feeding tube or observe?

3 Answers available

Would you recommend adjuvant chemoradiation for a resected ampullary adenocarcinoma?

What features would make you more likely to recommend radiation therapy with chemotherapy?

1 Answer available

What would you recommend for a patient with a new or locally recurrent anal cancer s/p chemoRT for anal cancer 15 years ago?

1 Answer available

What treatment would you recommend for a 3 cm basal cell carcinoma of the perianal skin with anal canal involvement?

The patient has no evidence of lymph node involvement.

1 Answer available

How would you treat oligoprogressive metastatic GIST to the liver with a single enlarging liver lesion while on imatinib and no other evidence of active disease, where surgery and RFA are not possible?

If you would recommend radiation therapy, what dose-fractionation would you utilize?

1 Answer available

Are there circumstances when you would consider re-irradiation of the esophagus in a patient who is not a surgical candidate or declines surgery?

1 Answer available

How would you recommend treating locally recurrent pancreatic cancer?

In a patient who has undergone resection and adjuvant chemotherapy who then recurs locally, how would you recommend treating? Would you treat ju...

1 Answer available

For postoperative gastric patients status post total gastrectomy, how do you approach anastamotic coverage?

Detailed instructions regarding lymph node coverage have been published, but how do you think about coverage of the anastamoses from the gastrectomy?

1 Answer available

Do you regularly utilize antiemetic or GI prophylaxis when treating abdominal sites with SBRT?

What timing do you recommend? What drug and what dose do you use?

1 Answer available

How would you approach a young patient with metastatic rectal cancer and a painful local recurrence who underwent chemoRT to 50.4 Gy two years ago and declined surgery?

1 Answer available

How would you mange true anal margin squamous cell carcinoma (with no involvement of anal canal) if wide local excision cannot be done and chemoradiation therapy is being used instead?

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...

2 Answers available

How would you manage a male with a prior history of localized prostate cancer s/p radiation to prostate only (two years ago), who now presents with a T1N0 squamous cell carcinoma of the anus?

Would your management change if the prostate and lymph nodes were treated with radiation two years ago?

2 Answers available

How would you treat very locally aggressive rectal cancer extending into muscle and causing internal iliac tumor thrombus, in a patient who is not a surgical candidate?

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...

1 Answer available

How do you approach patients with squamous cell carcinoma of anal canal with ano-vaginal fistula?

Do you consider diversion colostomy, or abdominoperineal resection up front?

4 Answers available

Do you ever treat patients with rectal or anal cancer with IMRT in the prone position?

1 Answer available

What is the best treatment approach for locally advanced (T3+ and/or N+) rectal cancer status post low anterior resection in a patient who has a remote history of seed implant for low risk prostate cancer?

What are your thoughts on dose, avoidance structures, re-tx risk, etc?

1 Answer available

Should inoperable squamous cell carcinoma of the esophagus be treated to doses > 60 Gy?

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...

2 Answers available

How do you manage grade 3 dermatitis during chemoradiation therapy for anal cancer?

Aquaphor, barrier cream, sitz baths, domboro, silvadene, foam dressings?

8 Answers available

In what situations do you recommend preoperative chemoradiation for gastric cancer?

1 Answer available

Should patients who received pelvic radiation get colonoscopy screenings more often than what is recommended for the general population?

In view of higher risks of rectal cancer after pelvic radiation, is more frequent screening warranted?

1 Answer available

Do you routinely use any type of motion management or breathing techniques when treating a lower esophageal cancer?

3 Answers available

How do you manage gastroesophageal junction cancer after resection with a positive circumferential surgical margin when no neoadjuvant treatment has been given?

1 Answer available

Would you recommend adjuvant chemoradiation for T1N0 gastric adenocarcinoma status post R0 resection but no D2 lymph node dissection?

Does the lack of D2 dissection automatically necessitate adjuvant chemoradiation therapy (ie <5 LN obtained)? Would the presence of high risk facto...

1 Answer available

Would you use standard neoadjuvant chemoradiation for a patient with advanced rectal cancer and a history of previous pelvic RT for another cancer?

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...

2 Answers available

When would you consider initial induction chemotherapy (e.g. FOLFOX) followed by neoadjuvant chemoradiation, over neoadjuvant chemoradiation alone, in patients with locally advanced rectal cancer?

2 Answers available

How do you manage unresctable thoracic esophageal cancer invading the trachea?

What chemotherapy and radiation doses/fractionation would you use once the airway has been stabilized to provide reasonably safe and effective palliat...

1 Answer available

What is your preferred palliative regimen for pancreatic cancer with pain related to celiac plexus involvement?

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...

2 Answers available

When treating adenocarinoma of the pancreas to 75 Gy in 25 fractions, what dose constraints do you use for small bowel, large bowel, and stomach?

What are your fields? Do you treat nodes electively?

1 Answer available

When treating an inoperable patient with squamous cell carcinoma of the thoracic esophagus, do you ever dose escalate beyond 50.4Gy?

What doses do you use?

1 Answer available

When treating a patient with anal cancer with a vaginal dilator, do you routinely simulate the patient with and without the dilator in place?

How often do patients become unable to tolerate the dilator during the treatment course secondary to discomfort related to acute toxicity?

3 Answers available

How would you treat a p16+ small cell neuroendocine tumor of the anal canal with or without metastatic inguinal lymph node metastasis?

Would the radiation dose and fields be the same as for squamous cell carcinoma? What chemotherapy would you recommend?

2 Answers available

When treating recurrent rectal cancer with re-irradiation using accelerated hyperfractionation (39-45 Gy at 1.2 or 1.5 Gy BID), what normal tissue constraints would you recommend for the bladder and bowel?

1 Answer available

What dose of radiation do you use for neoadjuvant chemoradiation in esophageal cancer?

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...

5 Answers available

In a thin patient with anal cancer, do you use bolus over the inguinal nodal volume when treating with an IMRT technique?

2 Answers available

What positioning and immobilization technqiues do you use for anal canal carcinoma radiotherapy in the era of IMRT?

On the heels of the discussions regarding skin toxicity prophylaxis and treatment, I am interested in your thoughts and current practice regarding pat...

1 Answer available

What dose do you typically prescribe to the primary tumor for definitive treatment of squamous cell carcinoma of the anal canal (given concurrently with chemotherapy)?

Do you have different preferences based on T-stage?

6 Answers available

How would you treat an early-stage gastric adenocarcinoma in a patient who is medically inoperable and not fit enough for chemotherapy?

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...

3 Answers available

What approach have you found works best in treating persistent acute radiation proctitis in patients undergoing pelvic EBRT?

2 Answers available

How do you manage patients with history of multiple perianal condylomas who develop focal high grade squamous intraepithelial lesions in the anal margin?

What would be your preferred management, surgical resection or radiation? If radiation is contemplated, what dose would be appropriate and would HPV s...

2 Answers available

What factors determine the choice of treatment in the management of intermediate (BCLC stage B) hepatocellular carcinoma?

What features would help you decide between TACE vs. TARE vs. external beam radiation therapy?

1 Answer available

What are your preferred target doses for bulky T4 rectal adenocarcinomas with extensive GU and anal sphincter involvement as well as common illiac and inguinal adenopathy, as part of total neoadjuvant therapy when future APR is planned?

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 ...

1 Answer available

What volumes and prescription doses do you use when treating patients with unresectable cholangiocarcinoma?

Do you electively treat nodes and how does your approach change with intra- or extra-hepatic primaries?

1 Answer available

In locally advanced rectal cancer treated with total neoadjuvant therapy, do you adjust boost volumes to only include post-chemo gross disease/nodes plus a margin?

1 Answer available

What types of sexual side effects do you discuss with men undergoing radiation therapy for rectal and/or anal cancer?

Is there a risk for anejaculation?

2 Answers available

Can you skip elective inguinal treatment in PET negative squamous cell carcinoma of anal canal?

2 Answers available

Which patients would you offer a watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer?

Based on the UK OnCoRe matched cohort analysis, would you offer a watch-and-wait approach off protocol or are you uncomfortable treatin...

5 Answers available

How would you approach treatment in recurrent, localized rectal mucinous adenocarcinoma?

Would you consider repeating neoadjuvant chemo/RT? Does this, occurring in the context of Lynch Syndrome, change the treatment approach?

1 Answer available

How do you manage early stage anal or anal margin cancer that is locally excised with negative but close margins when going back for wider margins would require an APR?

4 Answers available

How would you treat a synchronous anal and oropharyngeal squamous cell carcinoma?

If the oropharyngeal cancer is operable (ex T1N1), would would your preference be upfront surgery? Would you use chemoradiation therapy to bo...

1 Answer available

How would you approach a low-lying rectal cancer wtih para-aortic lymphadenopathy?

Would you recommend only chemotherapy or would you offer chemotherapy followed by restaging and possible definitive CRT and surgery?

3 Answers available

How do you manage a patient with a 3.5 cm squamous cell carcinoma of the perianus (with no involvement of the anal canal) with a positive inguinal node?

Are the treatment volumes the same as those for squamous cell carcinoma of the anal canal?

1 Answer available

When treating younger men with anal cancer do you consider dose to the prostate?

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...

1 Answer available

How would you manage a patient with a very large adenocarcinoma of the rectum (10 cm) that extends to the anal verge with positive peri-rectal and inguinal lymph nodes, but no distant organ involvement?

Is this patient considered to have metastatic disease? Should definitive surgery be considered?

1 Answer available

How would you manage a patient who presented with synchronous squamous cell carcinoma of the anus (cT2N0) and adenocarcinoma of the rectum (cT3N0) at 7cm from the anal verge?

1 Answer available

For rectal cancer with solitary liver metastasis, do you recommend neoadjuvant chemoradiation?

Are these patients better candidates for preop chemotherapy alone?

2 Answers available

Would you consider PCI for a patient with neuroendocrine carcinoma of the esophagus?

1 Answer available

What are your treatment volumes for patients with gastric cancer receiving adjuvant chemoRT for a positive margin following gastrectomy and D2 nodal dissection?

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...

1 Answer available

Would you ever recommend radiation alone for a T1N0 anal cancer?

1 Answer available

What is your treatment algorithm for solitary hepatocellular carcinoma, 3-5 cm, non-operative candidate but Child-Turcotte Pugh A/B?

Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT? What if the size is >5 cm?

1 Answer available

How do you treat localized esophageal carcinoma in patients who are unwilling or unable to undergo chemotherapy or surgery?

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...

1 Answer available

When would you add an extra radiation dose to compensate for treatment breaks?

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...

1 Answer available

What dose fractionation would you recommend for large (>5 cm) perianal Bowen's disease (squamous cell CIS)?

1 Answer available

What dose constraint(s) would you use for a patient with a pelvic kidney transplant getting pelvic RT?

1 Answer available

Is extensive abutment of the duodenum without invasion a contraindication to SBRT for pancreatic tumors?

If so, how do you quantify this when making a decision about who may or may not be a candidate for SBRT?

1 Answer available

What methods do you use to decrease genital skin reaction when delivering pelvic radiation to patients in the prone position?

1 Answer available

How would you manage a patient with synchronous locally advanced H&N (p16+) and locally advanced rectal adenocarcinoma?

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...

2 Answers available

Would you consider post operative boost radiation for positive margin in a patient with rectal cancer who underwent short course RT(25 Gy in 5 fractions) prior to TME?

What fractionation would you use?

2 Answers available

Would you consider induction chemotherapy prior to starting chemoradiation therapy in squamous cell carcinoma of the esophagus?

If the patient has large, bulky nodes would you consider starting after chemotherapy for cytoreduction? Or otherwise consider replanning mid-treatment...

2 Answers available

What treatment do you recommend for patients with Siewert III gastroesophageal junction cancer with periesophageal or mediastinal lymph node involvement beyond what is considered regional for gastric cancer?

Would you recommend chemoradiation therapy or chemotherapy upfront?

1 Answer available

How would you manage an inguinal-only recurrence of a previously treated low lying rectal cancer?

Any role for surgery? What radiation volumes would be used?

2 Answers available

How do you manage urgency and frequency of bowel movements secondary to radiation proctitis?

1 Answer available

Which chemotherapy regimen do you prefer for concurrent treatment with radiation therapy for anal squamous cell carcinoma?

5FU/mitomycin C or 5FU/cisplatin? Is there any benefit of cisplatin in terms of skin toxicity?

2 Answers available

How would you treat an excised T1N0M0 anal canal well-differentiated squamous cell carcinoma with positive microscopic margin?

Do you recommend 5FU/mitomycin chemoradiotherapy or radiotherapy alone? What evidence is there for efficacy and toxicity differences between the two ...

3 Answers available

Do you prefer to treat patients prone (on a belly board) or supine when treating rectal cancers?

Is there any evidence to show that treating with a bellyboard is preferred?

3 Answers available

How would you manage locally advanced anal cancer patients with PET positive para-aortic lymph nodes?

2 Answers available

Does external iliac coverage, such as in a T4 primary, justify IMRT for rectal cancer?

2 Answers available

Do you offer adjuvant radiation therapy for patients with hepatocellular carcinoma status post partial hepatectomy with positive parenchymal margins?

What dose and volumes would you use?

2 Answers available

Would you consider observation instead of a Whipple in a borderline resectable pancreatic cancer patient treated with neoadj CRT who has a radiographic CR?

If the patient received neoadjuvant FOLFOX for 4 cycles then 50.4 Gy with concurrent capecitabine, is that enough treatment to omit surgery?

1 Answer available

How would you manage a patient with distal rectal adenocarcinoma involving the anal canal and a single non-bulky inguinal nodal metastasis?

Is curative intent surgery off the table?

4 Answers available

Would you give post-operative radiation therapy and/or chemotherapy after an APR for anal cancer if inguinal lymph nodes were involved but margins were negative?

Surgery showed 1/5 and 1/4 LNs involved in the groins. What areas would you cover and with what corresponding doses?

1 Answer available

Would you boost a positive margin (R1 resection or R2 resection) in a GEJ esophageal carcinoma that completed neoadjuvant chemoradiation?

What if the patient was not a candidate for additional chemotherapy? Would your answer change if the patient received the CROSS regimen with <...

1 Answer available

Has SBRT shown to improve OS or PFS in patients with localized pancreatic cancer who are not a eligible for surgery due to other comorbidities?

2 Answers available

How do you treat anal adenocarcinoma?

Is the approach chemoradiotherapy (Mitomycin-5FU) as for squamous carcinoma with surgery only for salvage or do you always perform surgery after neo-a...

1 Answer available

Can short course radiation therapy (5 Gy x 5 fractions) be given for low lying rectal tumors, near the sphincter but not involving it?

Is there a risk of increased sphincter tone issues in these patients?

2 Answers available

What SBRT dose and tissue constraints would you choose for a presacral rectal recurrence status post preoperative chemoradiation to 50.4 Gy followed by surgical resection in a patient who is not a candidate for surgical re-resection?

1 Answer available

For liver metastases, what criteria do you use to decide between SBRT vs Y90?

Is there a benefit of SBRT over Y90 or vice versa?

1 Answer available

Would irreversible elctroporation (IRE) performed at the time of Whipple affect your plans or dose for radiation in the setting of adjuvant treatment for pancreatic adenocarcinoma?

1 Answer available

What is the appropriate follow up after chemoradiotherapy for patients with anal SCC?

Is obtaining serial MRIs or other imaging appropriate?

1 Answer available

Would you consider maintenance therapy for patients who achieve complete response after palliative chemoradiation for metastatic distal esophageal adenocarcinoma?

If so, what regimen would you consider?

1 Answer available

What is the role of radiation in regionally recurrent gastric cancer?

In a patient who received upfront surgery and chemotherapy who later recurred in the regional nodes, s/p lymphadenectomy, would you offer RT? If...

1 Answer available

How would you approach isolated inguinal lymph node squamous cell carcinoma of occult primary?

If workup is negative for a primary lesion, would you consider prophylaxis of potential primary sites (anus/vulva?), and would you treat bilateral ing...

1 Answer available

What is the preferred palliative regimen for elderly patients with rectal cancer who elect to forego surgery?

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...

2 Answers available

What target volumes do you use for rectosigmoid / very superior rectal cancers?

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 ...

2 Answers available

What techniques do you use to minimize gas artifacts on cone beam CT when treating upper abdominal lesions?

Antacids? Anti-motlity agents? Dietary changes? Combination?

1 Answer available

In what situations do you recommend adjuvant radiotherapy for colon cancer?

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 ...

2 Answers available

What cumulative dose constraints would you use for the normal liver when repeating SBRT for liver metastases with a longer time interval (i.e. 2-3 years)?

Do you factor in the time interval when deciding cumulative dose constraints?

1 Answer available

Would you consider BID treatment for a patient with a pelvic SCC (e.g. cervix or anal) if a significant amount of treatment days have been missed?

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...

1 Answer available

When is radiation indicated in the treatment of perianal paget's disease?

A nuimber of options for treatment but not a lot of great data for this rare disease.

1 Answer available

Do you treat inguinal lymph nodes for rectal cancers involving the anal canal?

The RTOG contouring atlas doesn't give a consensus on this issue.

4 Answers available

How do you do immobilization for liver SBRT?

What method provides the best reproducibility? Abdominal compression? Inhale breath hold? Exhale breath hold?

1 Answer available

How do you manage a patient with gastric/GE junction carcinoma who has positive lymph nodes at resection after neoadjuvant chemotherapy?

If you would elect for adjuvant therapy, which study helps guide your choice of regimen?

1 Answer available

How would you manage dysphagia and odynophagia in an otherwise healthy patient with newly diagnosed metastatic esophageal cancer with a large primary in the mid to distal esophagus?

Would you send the patient for a stent or do palliative RT?

4 Answers available

When giving hypofractionated ablative doses of radiation for cholangiocarcinoma, do you give concurrent Xeloda or hold chemo during radiation?

http://ascopubs.org/doi/full/10.1200/JCO.2015.64.2710

1 Answer available

Would you recommend repeat radiation therapy for a painful perineal recurrence in a patient who failed definitive CRT, and recurred again after salvage abdominoperineal resection (APR)?

What would be the RT dose and what percentages would you quote for toxicities? Would you recommend consideration of surgery instead?

2 Answers available

When is it appropriate to recommend a diverting colostomy for treatment of anal cancer or low lying rectal cancer?

Fecal incontinence can be one indication. What are others?

2 Answers available

What is the appropriate role for radiation therapy in patients with HCC or intrahepatic cholangiocarcinoma who are transplant candidates?

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...

1 Answer available

What is the appropriate dose and volume for adjuvant treatment of a sigmoid colon adenocarcinoma adherent to the L5 vertebral body with a positive radial margin?

2 Answers available

Do you offer adjuvant radiotherapy for pancreatic adenocarcinoma following surgical resection?

Given lack of strong evidence supporting the benefits of adjvuant RT in resected pancreatic adenocarcinoma (with results of the ongoing RTOG 0848 unav...

1 Answer available

Do you ever offer repeat radiation for hepatobiliary cancers in cases of local recurrence after definitive external beam or SBRT?

If so, what constraints would you use for central biliary and other normal structures and what dose/fractionation would you use?

1 Answer available

Can pre-op chemoRT be used to potentially downstage an early stage rectal cancer (i.e. T2 N0) for a sphincter sparing operation?

4 Answers available

In a male patient with a single inguinal node containing SCC, with no identifiable anal or penile lesions, what areas would you cover and to what dose?

Would you treat the node alone, unilateral/bilateral inguinal nodal basins, or cover any possible primary locations such as the anal mucosa?

1 Answer available

For patients receiving concurrent chemoradiation for anal cancer, what is your ANC threshold for holding radiation or switching to a boost plan to limit myelotoxicity?

1 Answer available

Have the results of LAP07 caused your institution to pursue more aggressive systemic therapy before radiotherapy in the treatment of pancreatic cancer?

Is better systemic control needed to make radiation therapy beneficial?

1 Answer available

When treating prostate or other pelvic malignancies, what dose constraints do you use for the sigmoid colon?

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...

1 Answer available

Would you recommend an inguinal node dissection as part of definitive treatment for adenocarcinoma of the anus with suspicious inguinal nodes?

What about bulky nodal disease?

1 Answer available

How do you treat hiccups in cancer patients?

Does your management differ if the hiccups are felt to be related to chemotherapy as opposed to the disease itself?

1 Answer available

What dose constraint, if any, do you use for the diaphragm when treating liver or lung tumors with SBRT?

Have you ever seen toxicity related to diaphragm dose with conventional fractionation?

4 Answers available

In patients with newly diagnosed cervical esophageal cancer with limited metastatic disease, do you treat the primary with chemoradiation?

1 Answer available

What treatment volume is appropriate when treating postoperatively for esophageal carcinoma?

In what situation, if ever, do you include mediastinal nodes?

1 Answer available

How do you optimize nutrition for patients experiencing dysphagia while undergoing chemoradiation therapy for esophageal cancer?

Is there a preferred method and should any of the following be avoided: esophageal stent, nasogastric tube, PEG, J-tube, or TPN?

1 Answer available

How do you approach bowel constraints in the setting of reirradiation?

Do you assume some recovery since the prior course of RT? If so, how much over what time period?

1 Answer available

In light of the recently published LAP07 trial, what is the role of radiation in unresectable pancreatic cancer?

In LAP07's second randomization (capecitabine+54 Gy vs maintenance gemcitabine +/- erlotinib), 60% of unresectable pancreatic cancer patients who did ...

3 Answers available

What GTV to CTV margin do you typically use for the primary lesion in anal cancer?

RTOG 0529 guidelines were 2.5cm margin from GTVA to CTVA (except bone or air), do you still follow this practice?

1 Answer available

How would you treat locoregionally recurrent anal CA?

If a patient developed locoregional recurrence after initial chemoradiation, would resection of known disease followed by observation be preferred?

1 Answer available

Are there situations in which elective nodal volumes may be reduced for T1/T2N0 anal SCC?

Is inguinal coverage always required?

3 Answers available

Do you recommend neoadjuvant chemotherapy or induction chemo + chemoRT for borderline resectable pancreatic cancer?

With the current data, I'm struggling to justify addition of radiation for potentially resectable disease. If in favor of RT, do you recommend s...

3 Answers available

For esophageal and gastroesophageal junction cancers, which lymph nodes are metastatic versus regional?

Specifically, are hilar nodes metastatic?

1 Answer available

Is acute pancreatitis a contraindication to radiotherapy for patients with pancreatic cancer?

Does treatment of the pancreas with radiotherapy during an episode of acute pancreatitis increase the risk of acute and late side effects? Should one ...

2 Answers available

Given the significant risk of recurrence after chemoradiation for locally advanced anal carcinoma, should resection be considered (with or without neoadjuvant treatment) in select cases?

At other sites we consider locally advanced disease and high risk of recurrence a contraindication for organ preservation. Would surgery improve likel...

1 Answer available

How do you treat anal margin tumors?

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...

1 Answer available

Is it safe and appropriate to palliatively treat abdominal or thoracic tumors with concurrent chemotherapy when using fractions of 250-300 cGy?

For example, there is a retrospective series out of MD Anderson (Kim, Acta Oncologica 2008) wherein 37 patients with gastric cancer were treated with ...

2 Answers available

What is the optimal dose fractionation for treating liver metastases in the central liver causing obstruction of biliary flow?

Will higher doses per fraction increase the risk of fibrosis and cause permanent impediment to biliary flow?

1 Answer available

Are there any special considerations when treating a patient with anal cancer who has poorly managed HIV/AIDS?

2 Answers available

Is there an advantage in treating with a SIB (simultaneous integrated boost) over sequential boost for anal cancer?

1 Answer available

In what situations, if any, do you offer postoperative radiation or chemoradiation for patients with squamous cell carcinoma of the esophagus?

Would your recommendation change if the histology was adenocarcinoma (excluding GE junction tumors)?

2 Answers available

How do you interpret the results of the ACT II trial in terms of the choice between cisplatin and mitomycin in the treatment of anal cancers?

Reference: https://www.ncbi.nlm.nih.gov/pubmed/23578724

1 Answer available

Do you base liver SBRT dose fractionation on size, volume, or proximity of normal tissue?

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...

3 Answers available

When treating borderline resectable pancreatic adenocarcinoma patients with neoadjuvant chemoradiation, do you treat the elective nodal regions or the primary alone?

Is your approach similar in unresectable disease? Is there evidence to support one approach over the other?

2 Answers available

In a patient with a small cell of the esophagus in which trimodality therapy is planned what dose of preoperative radiation would you use and would you utilize BID fractionation?

1 Answer available

How do you approach disease monitoring in patients with localized rectal cancer who have received treatment with chemoradiation?

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...

1 Answer available

In a patient with a large condyloma adjacent to a squamous cell carcinoma of the anal canal being treated with chemoradiation how would you incorporate the condyloma in the target volume if it is PET negative and would it receive a different dose?

2 Answers available

Do you electively cover the celiac axis in a patient with node negative middle third to distal, and GEJ esophageal carcinoma?

What factors do you use in deciding whether or not to electively cover the celiac axis?

1 Answer available

How do you manage unresectable esophageal cancer involving both the thoracic esophagus and GE junction?

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...

3 Answers available

What maximum volume (in cc's) of small bowel would you allow to receive 45 Gy in a patient with node positive squamous cell carcinoma of the anal canal receiving concurrent chemoradiation with 5-FU/MMC being treated with IMRT?

What if a large portion of small bowel is located within PTV45?

1 Answer available

When treating a high grade neuroendocrine tumor of the rectum with involved pelvic lymph nodes, do you use the same approach (dose, fractionation, concurrent chemotherapies) as you would for a small cell lung cancer?

Would you use platinum/etoposide concurrent with radiation or would you opt for platinum only during radiation? Would you use BID fractionation...

1 Answer available

Should capecitabine be administered at a specific time prior to RT in pre-op chemoradiation treatment for rectal cancer?

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...

1 Answer available

Is it feasible to treat central liver tumors +/- portal vein thrombus with SBRT while minding central hepatobiliary tract constraints?

The Stanford report (Osmundson, IJROBP 2015) on central hepatobiliary tract toxicity recommended dose constraints to the cHBT that would limit dose to...

2 Answers available

Would you advocate for sphincter preserving chemoradiation therapy for a patient with a diagnosis of anal canal carcinoma who has previously been treated with pelvic radiation such as EBRT or brachytherapy?

How would your radiation treatment approach change in terms of dose and target definition? Would the time interval between diagnosis affect the optio...

2 Answers available

Is there any role for adjuvant radiation for a low grade, intraductal papillary mucinous neoplasm (IPMN) of the pancreas after resection with a positive pancreatic margin?

1 Answer available

When treating locally advanced/borderline resectable pancreatic cancer with SBRT, what are the typical duodenal dose constraints you utilize?

2 Answers available

What is your typical target/field when treating a patient with 5 Gy x 5 fractions pre-operatively for rectal cancer?

Do you target the whole pelvis or a smaller "boost-like" field?

2 Answers available

What would you include in the radiation field for a patient with T2 N0 M0 adenocarcinoma of the distal 1/3 of the esophagus?

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?

1 Answer available

Is it acceptable for a medical oncologist to use Xeloda in place of 5FU when treating GI sites other than rectal?

Specifically - anus, pancreas, gastric?

2 Answers available

Is it appropriate to use SBRT on unresectable pancreatic tumors invading the duodenum?

Do you use any age limit to determine whether pancreatic SBRT is appropriate?

1 Answer available

Should patients with anal canal SCC undergo an FNA biopsy of any palpable inguinal LN that is also FDG avid on PET/CT or should these nodes be assumed to be positive and treated to a higher dose?

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 ...

1 Answer available

What adjuvant therapy recommendations would you make for a patient with pT3N0M0 duodenal cancer?

In a case with negative margins, would you consider chemotherapy alone or sequence with chemoradiation?

1 Answer available

Is chemoradiation the preferred treatment for T2 SCC of the anal canal in a patient with IBD?

Does the presense of ulcerative colitis, now in remission, affect your dose and fields?

1 Answer available

How do you use a 4D CT to account for hepatocellular carcinoma tumor motion?

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...

2 Answers available

Is there an "ideal" method for abdominal motion control when treating upper abdomen malignancies?

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 ...

1 Answer available

Are special precautions necessary for esophageal cancer with tracheal invasion prior to chemoradiation?

Are there any precautions to prevent formation of a TE fistula?

1 Answer available

What is your preferred dose for definitive radiation of squamous cell cancer of the thoracic esophagus that will be combined with chemothererapy?

Would your approach change if the histology were adenocarcinoma?

1 Answer available

How do you manage patients with low-lying rectal adenocarcinoma who refuse surgery?

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...

1 Answer available

For patient with primary liver carcinoma, is prior radioembolization with Yttrium-90 microspheres a contra-indication (relative or absolute) to external beam radiation therapy with either stereotactic body radiation therapy (SBRT) or proton beam therapy ?

2 Answers available

Would you treat the inguinal nodes in a patient who had an adenocarcinoma excised from the anal canal?

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?

2 Answers available

What is the evidence that there is a benefit to giving doses higher than 3060 cGy-3600 cGy in the elective treatment of uninvolved lymph nodes in the treatment of SCC of anal canal with chemoradiation?

3 Answers available

How do you treat locally advanced, operable, Siewert 3 GE junction adenocarcinomas?

1 Answer available

Is liver radiotherapy contraindicated in patients with Child-Pugh C liver function?

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)?

4 Answers available

For elderly patients with locally advanced rectal cancer who are not candidates for surgery or chemotherapy, what would be an appropriate palliative regimen?

1 Answer available

Do you recommend adjuvant chemoradiation for T2N0 gastric adenocarcinoma?

In a patient with an R0 resection, would you routinely recommend postop chemoradiation, since these patients were included in the MacDo...

1 Answer available

When treating pancreatic cancer with adjuvant chemoradiation, do you treat the initial field to 50 Gy, as per RTOG 0848, or to 45 Gy?

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?

2 Answers available

In what setting do you omit adjuvant radiation therapy in a T3N0 rectal cancer?

The NCCN guidelines categorically recommend adjuvant XRT for a cT1-2N0 rectal adenocarcinoma upstaged to a pT3N0, yet there are multipl...

1 Answer available

What dose and upper field border would you use following transanal excision for rectal cancer found to be T2 by final pathology but without LVSI or perineural invasion?

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...

1 Answer available

Following transanal excision with positive margins for for T1 or T2 rectal cancer, is it more appropriate to proceed with APR or attempt sphincter preservation with RT/Chemo?

If RT/chemo is preferred, what is an acceptable final boost dose?

1 Answer available

What is the appropriate treatment for a low lying rectal cancer in the setting of prior definitive prostate IMRT?

Fore example for a T3N0 rectal cancer on EUS?

1 Answer available

What dose and volume would be recommended for a medically inoperable patient with a T4 Rectal adenocarcinoma?

Would you boost to >54Gy? 60Gy? Is there relevant literature/evidence for supporting a higher dose?

1 Answer available

When treating rectal cancer with neoadjuvant chemoRT, is it appropriate to employ IMRT planning, rather than 3D conformal, for all cases, or should IMRT be reserved for special circumstances?

1 Answer available

Is it possible to palliate presacral recurrences of rectal cancer in patients who previously received neoadjuvant chemoradiation to the rectum?

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...

1 Answer available

For a GE junction tumor with a lymph node distant from the primary site, would the treatment volume be contiguous?

I.e. Would you treat most of the normal esophagus to include a mediastinal lymph node?

1 Answer available

How do you manage squamous cell carcinoma in situ of the anus?

While the Nigro/Wayne state regimen consisting of Mito C & 5FU is well stablished for squamous cell carcinoma of the anus/perianal tissue, a...

1 Answer available

For a patient who has undergone preoperative chemoradiation to 50Gy for locally advanced rectal cancer followed by LAR or APR, would you treat a positive margin with radiation therapy?

If so, what dose?

2 Answers available

How do you contour distal esophageal cancer in the postop setting after Ivor-Lewis pT3N3 (perigastric and periesophageal LN)?

What regional lymph nodes do you include perigastric, portahepatic, periesophageal, celiac, splenic, pancreaticoduodenal, sup. mesenteric, paraesophag...

1 Answer available

Has pelvic MRI replaced EUS as the standard of care for rectal cancer staging?

Are there any indications to choose one over the other?

1 Answer available

What is the likelihood of a successful pregnancy following pelvic irradiation?

How should we counsel young women who are receiving treatment for GI/GYN malignancies?

1 Answer available

How do you treat synchronous rectal cancer and prostate cancer?

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.

2 Answers available

Which regimen is better for gastric adenocarcinoma- neoadjuvant chemotherapy or adjuvant chemoradiation?

Is there a consensus on the MAGIC v. MacDonald debate?

2 Answers available

Is there a role for PET/CT in pancreatic cancer staging or treatment planning?

I recently had a patient with unresectable disease ask for a PET before starting RT but I’m not sure there is a benefit.

1 Answer available

How do you justify adjuvant radiotherapy in pancreatic cancer?

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...

1 Answer available

Should I use PET/CT for GE junction treatment planning?

We use PET for esophageal, but not gastric cancer. GE junction seems like a grey area.

1 Answer available

Do you stage and treat GE junction tumors like gastric or esophageal cancer?

1 Answer available

Do you ever give postoperative chemoradiation in patients who underwent preoperative chemotherapy for gastric adencocarcinoma?

1 Answer available

How do you control for organ motion when treating pancreatic cancer?

What techniques work best?

2 Answers available

Papers discussed in this category

N. Engl. J. Med., 2012-05-31

Preoperative chemoradiotherapy for esophageal or junctional cancer.

Lancet Oncol., 2015-09-01

Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial.

Cancer, 2007-11-15

Radiation therapy is associated with improved survival in patients with pancreatic adenocarcinoma: results of a study from the Surveillance, Epidemiology, and End Results (SEER) registry data.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-07-20

Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-07-20

Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975-2005).

Cancer, 1987 Jun 15

Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Gastrointestinal Tumor Study Group.

Ann Surg, 2007 Nov

Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891.

N Engl J Med, 2006 Jul 6

Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.

The New England journal of medicine, 2001-09-06

Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.

BMC Cancer, 2015-07-21

TOPGEAR: a randomised phase III trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer (an international, intergroup trial of the AGITG/TROG/EORTC/NCIC CTG).

J. Clin. Oncol., 2009-02-20

Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction.

Nature clinical practice. Oncology, 2005-05

Multidisciplinary treatment of synchronous primary rectal and prostate cancers.

Practical radiation oncology, 2012

Neoadjuvant chemoradiation followed by interstitial prostate brachytherapy for synchronous prostate and rectal cancer.

Urology, 1999-10

Combined radical retropubic prostatectomy and rectal resection.

Urology, 2001-04

External beam radiotherapy for synchronous rectal and prostatic tumors.

Int J Colorectal Dis, 2012-11-01

Management of synchronous rectal and prostate cancer.

International journal of radiation oncology, biology, physics, 2001-11-01

Elective groin irradiation is not indicated for patients with adenocarcinoma of the rectum extending to the anal canal.

Radiat Oncol, 2014-12-23

Is elective inguinal radiotherapy necessary for locally advanced rectal adenocarcinoma invading anal canal?

Lancet (London, England), 2009-03-07

Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial.

J. Clin. Oncol., 2012-06-01

Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years.

Br J Surg, 2006-10-01

Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-11-01

Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04.

International journal of radiation oncology, biology, physics, 2014-03-15

Five fractions of radiation therapy followed by 4 cycles of FOLFOX chemotherapy as preoperative treatment for rectal cancer.

Ann. Surg. Oncol., 2017 May 30

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Efficacy and Safety of Transarterial Chemoembolization Plus External Beam Radiotherapy vs Sorafenib in Hepatocellular Carcinoma With Macroscopic Vascular Invasion: A Randomized Clinical Trial.

Gastroenterology, 2012-07

Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 US centers.

HPB : the official journal of the International Hepato Pancreato Biliary Association, 2015-02

Adjuvant stereotactic body radiotherapy following transarterial chemoembolization in patients with non-resectable hepatocellular carcinoma tumours of ≥ 3 cm.

International journal of radiation oncology, biology, physics, 2018-01-01

Stereotactic Body Radiation Therapy as an Alternative to Transarterial Chemoembolization for Hepatocellular Carcinoma.

American journal of clinical oncology, 2015-12

Low Toxicity in Inflammatory Bowel Disease Patients Treated With Abdominal and Pelvic Radiation Therapy.

Lancet, 2019 Apr 11

Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial.

Ann. Surg. Oncol., 2017 Mar 23

TOPGEAR: A Randomized, Phase III Trial of Perioperative ECF Chemotherapy with or Without Preoperative Chemoradiation for Resectable Gastric Cancer: Interim Results from an International, Intergroup Trial of the AGITG, TROG, EORTC and CCTG.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-07-01

SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma.

Lancet Oncol., 2017 Oct 26

Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial.

The Lancet. Oncology, 2017-09

First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials.

JAMA oncology, 2017-04-01

Validation of a Risk Estimation of Tumor Recurrence After Transplant (RETREAT) Score for Hepatocellular Carcinoma Recurrence After Liver Transplant.

International journal of radiation oncology, biology, physics, 2007-12-01

Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy.

Cancer, 2011-09-01

Stereotactic body radiotherapy for colorectal liver metastases: a pooled analysis.

International journal of radiation oncology, biology, physics, 2015-07-01

Gastrointestinal Toxicities With Combined Antiangiogenic and Stereotactic Body Radiation Therapy.

Cancer treatment reviews, 2017-02

Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy: A systematic review.

Strahlenther Onkol, 2019 Feb 08

Combination of stereotactic radiotherapy and targeted therapy: patterns-of-care survey in German-speaking countries.

Radiother Oncol, 2018 Jul 09

Stereotactic body radiotherapy for colorectal cancer liver metastases: A systematic review.

J. Hepatol., 2019 Apr 06

Direct-acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients.

Clin Oncol (R Coll Radiol), 2017 Oct 13

UK Consensus on Normal Tissue Dose Constraints for Stereotactic Radiotherapy.

Annals of surgical oncology, 2015-12

Evaluation of Adjuvant Radiation Therapy for Resected Gallbladder Carcinoma: A Multi-institutional Experience.

Radiation Oncology

Gastrointestinal Cancers

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