Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there any volumetric constraints associated with toxicity in the dose range that is moderately above prescription (i.e. 30-35 Gy range), when planning hippocampal-sparing whole brain radiation?
This is an important question worth some discussion. As the question mentions, clinical trials of HA-WBRT have permitted a hot spot of 133% of the prescription dose of 30 Gy (or 40 Gy) to D2% of the whole-brain parenchyma as an acceptable protocol variation. Importantly, none of these trials have de...
What resection margins are required for DCIS with a component of invasive disease?
The SSO-ASTRO-ASCO guidelines of 2016 on margin status for patients with tumors that are pure DCIS or predominantly DCIS requiring a minimum of 2 mm for those receiving RT were based on a meta-analysis of (mostly older) published studies, not individual patient data. Three much more recent studies f...
When treating the whole brain with hippocampal avoidance, do you ever deliver SIB to gross disease?
There have been several papers and an ongoing trial evaluating the safety and efficacy of including SIB to macrometastatic disease with HA-WBRT. A recently published trial from the UT-Southwestern team was a single-arm phase II trial, which treated 50 brain metastasis patients with HA-WBRT to 20 Gy ...
How do you approach the decision to boost patients diagnosed with DCIS?
Based on prospective and also retrospective data Chua, AACR Volume 81, Issue 4 Supplement, pp. GS2-04. We would recommend for high grade, < 50 years and close margin and in the era of genomic testing to patients with high genomic score.
What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?
Patients with stage I rectal cancer treated with organ preservation require close surveillance to rule out tumor regrowth and local recurrence that may be salvaged with radical surgery. The highest risk of recurrence is within 2 years after completion of neoadjuvant therapy and patients should be fo...
Do you recommend chemoradiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?
Tough question, with lots of evolution in this area in the past few years. The data would suggest that for borderline resectable pancreatic cancer, there is a benefit in terms of OS from preoperative treatment. For unresectable disease, the small chance of conversion into resectability is worth the ...
What is the longest acceptable interval between hysterectomy and vaginal cuff brachytherapy for high/intermediate risk endometrial cancer in the age of COVID-19?
We usually start no later than 9 weeks post hysterectomy. It is based on this retrospective study.
Should we delay adjuvant breast radiotherapy for early stage breast cancers as the COVID-19 situation evolves?
This is a very tough question given the unprecedented nature of this pandemic and the fact that its duration is unknown. Recommendations will likely vary based on the density of cases in a specific geographic location and will undoubtedly change frequently given the rapidly evolving nature of this s...
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...
Do you use either memantine or hippocampal sparing technique to preserve cognitive function when giving whole brain radiotherapy?
Dr. @Dr. First Last and I put together the response below:We use memantine and hippocampal sparing technique for all brain metastasis patients who are planning to receive WBRT. This is based off the recently published phase III trial NRG CC001 that found hippocampal avoidance WBRT plus memantine res...