Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with micrometastatic node positive tumor post mastectomy (no neoadjuvant chemotherapy)?
Currently, I don’t offer PMRT for T1 and T2 disease with micromets unless triple negative or a multitude of adverse factors Mamtani et al., PMID 28429197
Is there really substantial evidence to avoid central lesions for SBRT?
Much has been learned since the cautionary data from Indiana University was published showing increased toxicity when using SBRT for centrally-located lung cancers. One should be aware that there is an increased risk when treating tumors in this location with SBRT fractionation schemes. I am aware o...
Do you place any constraint on Dmax when developing plans for linac-based SRS or SBRT?
Very rarely. I was a gamma knife SRS person before I started linac-based SRS so I am very comfortable with >120% hot spots. For brain linac based SRS we regularly push hotspots to 150% to get the steepest dose falloff (most similar to gamma knife plans prescribing to the 50% isodose curve). For body...
How would you treat a synchronous anal canal squamous cell carcinoma and localized high risk prostate adenocarcinoma?
The primary anal cancer and prostate cancer can be treated with a whole pelvic field to include the anus and prostate/SV (45-50 Gy) with a simultaneous integrated boost for the anal tumor (RTOG 0529). HDR brachytherapy can then be used to boost the prostate after a short recovery from the external b...
Are you using vaginal dilators during treatment of rectal cancer to spare anterior vaginal wall, or are you reserving this for anal cancers?
We are using vaginal dilators for any woman with anal cancer or rectal cancer who desires to be treated with one. This is most impactful when the dose is being delivered to the distal vagina, near the introitus, but we do not have data to determine a cutoff. Of course, many rectal cancers require tr...
For a patient with T3N1M0 esophageal adenocarcinoma, who suffered esophageal perforation necessitating metallic stent placement, would you favor a neoadjuvant chemoradiation or perioperative chemotherapy approach?
In situations of esophageal perforation, the main concern will be the dissemination of disease particularly in the thoracic cavity, i.e. pleura. Therefore, I favor a systemic therapy approach upfront. Should the patient have a good response to systemic therapy, then chemoradiation could be considere...
What is your preferred regimen for palliative treatment of unresectable retroperitoneal sarcoma?
First, I’d distinguish: 1) If the goals are PURELY palliative, can pick a conventional (30/10) or more adventurous (39/13, QuadShot, etc) palliative regimen - there is a separate MedNet thread on dose/fractionation for sarcoma palliation. But efficacy and durability are likely limited. 2) If the pri...
How often do you utilize intrafraction motion tracking when treating prostate cancer?
Why not?
Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?
This is an important question with implications for both overall survival (OS) and quality of life (QOL) where level-1 evidence is currently lacking. It is also the subject of an ongoing phase 3 trial (SWOG S1827/Maverick) that randomizes patients with limited-stage (LS) and extensive-stage (ES) SCL...
In a patient with T2N0 breast cancer with skin involvement s/p lumpectomy and negative margins, if you are offering whole breast radiation, would you bolus your tangent fields?
I tend to use small bolus over the scar area in this setting