Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a gliosarcoma s/p GTR with leptomeningeal spread?
This is an extremely challenging clinical situation. The overall annual incidence of gliosarcoma in the US is <250 cases. These tumors, which usually contain both an astroglial and a sarcomatous cell population have a propensity to spread throughout the CNS, using CSF flow pathways, and hence leptom...
What is a reasonable dose to treat the entire bladder for an muscle invasive, multi-focal bladder cancer in a non-surgical patient?
A variety of dosing schemes have been used in bladder-sparing trimodality (TMT) experiences from the US (RTOG/NRG trials) and the UK (BC2001 and BCON trials). In BC2001, one of the randomizations in the 2 x 2 design was to treatment of the entire bladder to the prescription dose (64 Gy in 32 fractio...
Do you prefer IMRT to 3D for partial breast treatment?
Prefer IMRT for better conformity, dose homogeneity, and less dose to uninvolved breast. Lung dose is not a clinically meaningful difference.
Do you routinely perform a breast boost after whole breast radiation?
In the setting of close margins, I would utilize a boost (after confirming that re-excision is not planned). More generally, I boost all patients <age 50 and older patients with higher risk features such as high grade disease, hormone negative disease, larger tumor size, and close margins where re-e...
Are there any accruing trials in the U.S. evaluating selective use of radiation after mastectomy in early stage breast cancer?
The SUPREMO trial results have not yet been presented or published. There are no trials currently open in the United States randomly allocating patients who have had up-front surgery between PMRT and observation. There is such a study in South Korea, entitled "Postoperative Radiotherapy in N1 Breast...
What dose/fractionation would you use for a multiply recurrent and now unresectable ameloblastoma involving the masticator space, pterygopalatine fossa, and right maxillary sinus?
70 Gy/35 fractions. If SCC component, treat the neck.
For a T1 true vocal cord cancer that is p16+ would you use standard dose (63 Gy in 28 fx) or use a lower dose of radiation?
Same.
Is it reasonable to treat a solitary plasmacytoma of the lung parenchyma with SBRT?
I have only treated one patient with solitary plasmacytoma of the lung over the past 15 years of doing lung SBRT. It is an extremely rare and unusual disease presentation for myeloma. Given the radiosensitivity of myeloma, I opted for 30 Gy in 5 fractions, which resulted in a completed response in t...
Would you re-RT for heterotopic ossification if the first course of postoperative radiation failed to prevent HO formation?
I routinely offer a second course.After the first course, the risk of secondary malignancy approaches zero - i.e., there are no documented cases in the literature. Seegenschmidt's paper with about 6,000 treated hips reported no secondary malignancy at 10-year follow-up. Now, what about after a secon...
For a patient s/p TORS with indications for adjuvant radiation, how does your management change with persistently elevated ctHPVDNA?
At this time, it's a bit challenging to make any meaningful treatment changes based on positive post-operative ctHPVDNA. But it certainly raises my suspicion - I would take a close look at the CT simulation for any potential grossly positive nodes (especially a retropharyngeal node that may not have...