Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a chest wall constraint you typically use for 60 Gy in 15 fraction NSCLC treatment?
We generally keep chest wall Dmax <110% and keep as much 105% out of the chest wall as possible, with a very low-priority goal of V4000 cGy <30 cc. I am definitely not strict about this in most cases, especially the volumetric goal.
What dose would you use for a plaque brachytherapy for a melanoma involving the iris?
The following isotopes have been used for radioactive plaque therapy to treat choroidal melanomas: 125I, 103Pd, and 131Cs as low-energy seeds, and 106Ru as β emitter. The dose used for uveal melanomas is between 80-90Gy with most studies reporting doses ~85 Shields et al., PMID 10980767. In this lar...
For esophageal and gastroesophageal junction cancers, which lymph nodes are metastatic versus regional?
I would say the short answer is no, hilar nodes are not regional nodes for esophageal of gastroesophageal junction cancers. The long answer would require a definition of what we're talking about when we say lymph nodes are "regional". This may have different definitions depending on the setting. F...
What BED10 do you aim for when prescribing hypofractionated treatment for ultra-central tumors of the lung?
BED10 (3) for the regimens listed above (and a few others) 50 Gy/5 fx: 100 Gy (216.67 Gy) 60 Gy/8 fx: 105 Gy (210 Gy) 70 Gy/10 fx: 119 Gy (233.33 Gy) 62.5 Gy/10 fx: 101.56 Gy (192.71 Gy) 60 Gy/15 fx: 84 Gy (140 Gy) 72 Gy/18 fx: 100.8 Gy (168 Gy) 77 Gy/25 fx: 100.7 Gy (156.05 Gy) 79.5 Gy/30 fx: 100.6...
Is there any evidence that radiotherapy can worsen balance, dizziness, or vertigo in patients treated for vestibular schwannoma due to transient edema?
While the answer from Dr. @Dr. First Last addresses a much broader category of patients treated with SRS, we have looked specifically at post radiation side effects after treatment of vestibular schwannomas treated with either SRS (12.5 Gy), hypofractionated SRS (hSRT with 5 fractions of 5 Gy), or c...
What is your cochlear dose constraint when treating acoustic neuromas with SRS in a patient with intact hearing?
The critical components of hearing susceptible to radiation toxicity of vestibular schwannoma treatment include acoustic nerve, cochlea, and brain stem. It is unclear which structure is responsible. It helps to understand the continuum of fibers from the endolymphatic receptors from cochlea to form ...
What are the common side effects that you observe with TTFields?
I think most patients do tolerate TTF. I’ve seen patients with concerns of skin irritation, but I think the bigger issue is the inconvenience and aesthetics.
What is the risk of secondary malignancy and/or conversion to MPNST for patients with NF-1 who undergo radiation?
Broadly speaking, this is certainly a possibility and this has been a reason why the community has triaged the application of radiotherapy to more high-risk cases (Williams et al., PMID 19117870). Just playing out the numbers independent of the application of radiotherapy, 100% of NF1 patients will ...
How would you treat a patient with cN1 MIBC, treated with neoadjuvant cisplatin-based chemotherapy with outstanding clinical response, who is no longer a cystectomy candidate?
This is certainly a not uncommon clinical scenario in practice with, unfortunately, limited prospective data. The ECOG ACRIN INSPIRE trial (EA8185) is aiming to generate key prospective data in this setting. For patients with node positive patients and great response to initial systemic neoadjuvant ...
What recommendations do you give to patients who ask about diet during breast cancer treatment?
Women with breast cancer are at risk of gaining weight during treatment. It is the perfect storm: Decreased activity and increased appetite from the steroids. Sometimes women think they are going to loose weight so they compensate - so informing patients of the risk is a first step. There are numero...