Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?
As simple as this question seems to be on the surface, it is actually a very difficult clinical scenario to opine with certainty, primarily because of a lack of data. So, let us address this with each option in mind, weighing the pros and cons: Observation: We do know that in resected patients, radi...
What ipsilateral lung constraints if any do you utilize for SBRT and or hypofractionated RT in the lungs?
Following up to this question, I wanted to see if there are any new thoughts on this. I think most rad oncs who I have asked, do not really utilize an ipsilateral lung constraint for SBRT or hypofractionated 60/15 style plans. I was wondering if this might be related to old school rules of thumb, li...
How would you treat a patient with p16 (-) neck lymph node metastasis of an unknown primary, considering their history of prior supraclavicular and chest wall irradiation?
The management of SCCUP is complex and individualized and I would argue that the mitigation of risk is most important in a patient who may be considered for reRT. I would probably favor neck dissection and search for primary with biopsies and at least ipsi tonsillectomy (esp if the LN is in level 2)...
For unresectable radiation induced angiosarcoma, what dose and fractionation would you use?
45 Gy at 1 Gy TID with 10 cm margins, boost to 60 Gy with same fractionation with 5 cm margins. If still incompletely resectable, 75 Gy. Outcomes have been published by NPM.
Would you favor post op radiation therapy for soft tissue sarcoma if a positive margin were still expected despite pre-op radiation?
The key question here is whether you are dealing with tumor ON the plexus, expected to result in a microscopically positive (R1) margin, or tumor IN the plexus, expected to result in gross residual disease (R2). If tumor is ON the plexus, a planned R1 margin on a critical structure, with addition o...
What volumes would you treat and what dose constraints do you use for breast and lymphatic re-irradiation?
H&N cancer brachial plexus re-irradiation data, “Among patients with a Dmax greater than vs less than 106 Gy, the 1-year cumulative incidence of brachial plexopathy (BPP) was 42% vs 4% P = 0.005. V80 > 1cc (1-yr cumulative incidence BPP 34% vs 4% P = 0.03) and V90 > 0.3cc (32% vs 4%, P = 0.046) asso...
Would you offer postmastectomy re-irradiation in a patient with locally advanced, ER-/Her2+ disease with pathologic complete response after neoadjuvant chemo?
Our threshold for PMRT for reradiation is high because the therapeutic ratio changes. Stage III her2 neu positive non inflammatory breast cancer treated with dual her2neu therapy with pCR would avoid RT.
Does a negative neck dissection adequately cover the treatment of the neck for a patient that clearly needs PORT for an oral tongue cancer?
I do not feel comfortable omitting RT to the neck in cases of oral tongue cancer. The lymphatic drainage of the oral tongue is complex. The textbook on Head and Neck Cancer by Million and Cassisi (2nd ed., Figure 16-31) has a nice representation of the crossing lymphatics of the oral tongue. From th...
In which situations can you spare the contralateral neck for oropharyngeal carcinoma?
The controversy on contralateral neck disease is whether this is impacted by efferent lymphatics from the primary or collateral flow in the neck from involved nodes.Thus with regards to the primary tonsil cancers that are T1,T2 well lateralized without involvement of the base of tongue nor soft pala...
How would you treat an ipsilateral retropharyngeal node recurrence in a patient with history of early stage oropharyngeal cancer managed by surgery and no previous adjuvant radiation?
RT to primary site, positive RP, and bilateral neck and concomitant chemo.