Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Have treatment recommendations changed for Stage I endometrial Cancer based upon PORTEC 4 results?
PORTEC-4a will almost certainly change recommendations for adjuvant treatment in high-intermediate risk stage I patients with endometrial cancer, and in at least 2 different ways, in my opinion. By following the molecular profiling guidelines, nearly half of these patients will avoid adjuvant treatm...
How do you determine dose for prostate SBRT?
The Stanford experience published by King et al was an important one describing a prospective experience of SBRT at dose levels of 35-36.25 Gy, and these dose levels were used based upon prior single institution retrospective reports from community practice settings where a good deal of experience ...
Is it necessary to use double contrast MRI for treatment planning of brain SRS?
"Necessary" is perhaps too restrictive a term, but speaking anecdotally, at Barrow Neurological Institute (BNI) we, for essentially the past 20 years, routinely obtain thin cut (1mm) SPGR double-dose gadolinium MRI to plan radiosurgery for patients with brain metastasis. In support of this, a recent...
What is your treatment algorithm for solitary hepatocellular carcinoma, 3-5 cm, non-operative candidate but Child-Turcotte Pugh A/B?
This really boils down to two issues: CTP score and size of the lesion. For patients who are CTPA with a lesion <3 cm, RFA/MWA or SBRT are good options although there is some data from the University of Michigan (Wahl et al., JCO 2014) that lesions > 2 cm are better served with SBRT. For solitary le...
In a patient with rectal cancer, when would you consider brachytherapy monotherapy or brachytherapy boost after CRT?
For a patient with cT2N0 disease, the most appropriate use of brachytherapy would be sequential with pelvic radiotherapy, the bulk of data being with long-course CRT. Brachy can either be done prior to CRT or sequenced afterwards. We routinely use brachytherapy in appropriate candidates in our pract...
Would you offer hypofractionated radiation regimens for a young patient with glioblastoma with good performance status but travel concerns, making 6 weeks of radiation difficult?
I am not a neuro-radiation oncologist, but I must register my disagreement with Dr. @Dr. First Last answer. This is GBM. The cure rate is exceedingly low, no matter what the fractionation, age of the patient, PS, etc. We should work with the patient to maximize their remaining quality of life and no...
How would you approach a radiation-induced angiosarcoma of the breast after mastectomy with negative margins?
Based on this research we tend to offer RT for high grade or tumor more than 5 cm or RT induced; there is no good prospective data. Based on UF series, we offer accelerated hyperfractionation 1.5 BID to 45 to 50 Gy, treating only chest wall.
Does non-urothelial histology impact your approach to chemoradiotherapy for muscle-invasive bladder cancer?
There is no randomized data available in this regard to guide us through non-urothelial histologies for MIBC. However, certain points that are worth considering in their management are: For small cell or neuroendocrine tumors, cisplatin/etoposide or ifosfamide/doxorubicin-based systemic therapy in ...
When do you consider re-irradiating patients with recurrent cervical cancer?
Because I have been seeing and treating a reasonable number of these cases for 35 years, I have some strong opinions on the matter. Although external beam re-irradiation in the setting of recurrent cervical cancer is fraught with great hazards and poor outcomes, interstitial re-irradiation has a hig...
Under what circumstances would brachytherapy be preferred over electron therapy for treating skin cancers?
For small (<2 cm) nonmelanoma skin cancers, I would say that brachytherapy is preferred for these reasons: Better cosmesis - 90-95% report excellent, which is better than electron series, particularly at the edge. Better for curved surfaces like the nose b/c applicator is flush on the skin with no ...