Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose do you typically prescribe to the primary tumor for definitive treatment of squamous cell carcinoma of the anal canal (given concurrently with chemotherapy)?
With IMRT: Primary TX and T1: 50 Gy/ 25 fx SIB to primary and 42 Gy microscopic T2: 54Gy /27 SIB and 45 Gy microscopic T3 58Gy /29 SIB and 47Gy microscopic T4 58Gy /29 SIB and 47Gy microscopic Nodes (all with no CTV/5mm PTV within the microscopic dose above): <2cm 50Gy SIB 2-5 cm 54Gy* SIB >5cm 5...
Would you recommend adjuvant radiation to the breast for low grade adenosquamous carcinoma after lumpectomy?
There is scarce data on these rare histologies. With lumpectomy given the uncertainties, I would offer radiation. This is likely triple negative as well. The latest guidelines on whole breast fractionation from ASTRO suggest that in these rare histologies that usually arise in other parts of the bod...
What are the realistic, modern 10-year survival curves for localized prostate cancer given the improvements we have made in diagnostics and treatment?
Generally, outcomes are excellent for the average patient with localized prostate cancer. As all-cause mortality is driven by competing risks for patients with localized prostate cancer, the age and overall health of a patient are often the most important prognostic factors to predict overall surviv...
In which patients with early stage rectal cancer treated according to the PROSPECT paradigm do you recommend adjuvant chemotherapy?
Great question and great observation. The most recent NCCN guidelines (version 1.2024-page REC-6) clearly listed neoadjuvant chemotherapy without radiation as an option for patients with no T4 disease eligible for sphincter-sparing surgery. After the neoadjuvant chemotherapy, if tumor regression is ...
Should I treat a patient who doesn't know she has cancer?
Interesting opinions. Wonder if anyone has their own experience. I will bite. My grandfather was diagnosed with mesothelioma (he had worked in a salt plant laden with asbestos). He had 9 children in North America and was staying with them. They chose, as a family, not to tell him he had cancer. We a...
Would you feel comfortable doing high tangents with ultra-hypofractionation?
I would have no problem. 26/5 to CW + regional nodes has been studied and they do fine - and that's a much larger volume. Can discuss pros and cons and pre-emptively discuss lymphedema management, but it appears to be reasonable.That being said, it's only 10 more treatments for a course that we know...
How do you manage unresectable esophageal cancer involving both the thoracic esophagus and GE junction?
We need to remember that RTOG-8501 treated the entire esophagus for the initial fields, so treating a large field is not unheard of. With modern day treatment planning and delivery, it would be reasonable to treat definitely to treat the entire CTV (defined as the esophagus and nodes) to 45 Gy and t...
Which genomic test do you choose for a patient with favorable intermediate prostate cancer trying to decide between active surveillance and treatment?
Decipher.
How would you approach radiotherapy planning for a pediatric patient with Ewing sarcoma of the spine (vertebral body primary)?
Per the recent AEWS 1031 protocol: GTV1 is defined as the visible and/or palpable disease defined by physical examination, CT, MRI, and/or PET prior to any surgical debulking or chemotherapy. GTV2 is defined as a residual visible or palpable tumor as assessed by CT, MRI, PET, or physical exam after ...
When treating rectal cancer with conventional neoadjuvant chemoradiation (45 Gy to pelvis with boost to 50.4 Gy), what volume do you use for the boost?
Great question. There does seem to be some variation in boost volume, particularly between 3D and IMRT treatments. At MDACC, we typically use a prone 3 field belly board technique for most rectal cancer patients receiving standard neoadjuvant long-course chemoradiation. The pelvis goes to 45Gy in 2...