Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer adjuvant treatment for resected colloid pancreatic carcinoma?
I rarely offer adjuvant radiation for typical pancreatic ductal adenocarcinoma except in cases of positive margins, and then only after an adequate duration of chemotherapy has been given. Therefore, I do not think adjuvant radiation therapy should be routine in colloid pancreatic carcinoma, which i...
Would you ever consider chemoradiation for bladder preservation in someone who has had prior LDR prostate brachytherapy?
The board answer is no, he should have a cystoprostatectomy, but that is often not practical. Bladder cancers may arise in men after the brachytherapy either as a result of that treatment or incidentally. The radiation induced cancers appear more than ten years later by which time the men may be in ...
Is there a role for dose escalation beyond 50.4 Gy in neoadjuvant chemoradiation therapy for rectal cancer?
There are probably a variety of opinions about this, but there is no proven role for doses higher than 50.4 Gy. Doses between 50Gy and 60Gy have been studied extensively, including a PhII trial reported by RTOG that was negative for pCR endpoint with 59Gy, and there is no dose response within this r...
How do you approach elective nodal irradiation in muscle-invasive bladder cancer?
The evidence regarding elective nodal irradiation (ENI) in patients undergoing organ preservation with chemotherapy and radiation is mixed, especially when considering data from surgical studies. A meta-analysis involving approximately 17,000 patients indicated that nodal dissection improved outcome...
Is reirradiation in the setting of DCIS of the breast ever appropriate?
If the question means DCIS as IBTR after previous surgery and RT, then would say, would follow the same criteria as IDC for reradiation. Long DFS (at least 2 years but prefer longer) from previous RT, able to get repeat lumpectomy with negative margin with reasonable cosmetic outcome, suitable for P...
How do the results of INSEMA and SOUND impact the decision of omitting SLND in young women with breast cancer and offering adjuvant RT to patients who would otherwise be candidates for omission?
Both trials required radiation so I would recommend it for a young woman not getting sentinel lymph node evaluation, and would lean toward whole breast irradiation. INSEMA required whole breast irradiation and SOUND allowed partial breast irradiation (10% of patients) but the majority of patients re...
How do you approach treatment of a subtotally resected low grade glioma in a young patient?
The management philosophy for LGG is radically shifting. For years, the belief was that these were essentially "incurable", slow-growing tumors, and hence the original debate centered around observation versus resection; the observation camp is now squarely in the minority. The debate then shifted t...
Are there any unique considerations for treating pediatric high grade glioma?
Trial availability, disease extent, age, specific molecular alterations, and family history should likely all play a role in choosing the most appropriate treatment paradigm.It’s expected that most future studies in pediatric high grade glioma will be stratified by their nascent biology, given that ...
Would you offer hypofractionation for a larger AVM?
When treating large (or giant) AVMs the dose-volume relationship can be unfavorable when using a single-session radiosurgery, resulting in high complication rates for effective dose. The obliteration rate for large AVMs treated with single fraction SRS is low (less than 50%). For this reason, other ...
Do you use any dose constraints for the spleen while delivering abdominal radiation therapy?
The prognostic impact of post-RT lymphopenia on overall survival has been suggested by studies in esophageal, lung and pancreatic cancers (among others).Sunil Krishnan and others at MDACC looked at the relationship between degree of post-RT lymphopenia and mean splenic dose for patients with pancrea...