Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What criteria do you use for replanning with a new CT simulation for patients being treated definitively for head and neck cancer?
Whenever nodal shrinkage or weight loss reduces the fit of the mask we make a new mask in same position and re-calculate doses using existing IMRT beam and dose fluences. Tumor dose never reduces based on our experience, and the main issue are doses to organs. Skin dose may increase and it may be wo...
For which patients, if any, do you typically order additional imaging workup for staging in early-stage breast cancer?
Many studies have shown the true-positive rate of distant metastases on pretreatment imaging to be a few percent (at most) for patients with Clinical Anatomic Stage I-II cancers. The false-positive rate is much higher. Hence, such imaging should only be used when patients have suspicious symptoms or...
For gastric cancer receiving FLOT perioperatively with negative margins but multiple positive nodes, do you offer postoperative chemoRT?
This is a question that is starting to come up frequently in clinical practice.The design of the FLOT study does not consider radiation or other changes in treatment if there is a poor response to the pre-operative chemotherapy. Purely based on the study, everyone would get post-operative FLOT, rega...
How do you define LVSI in breast cancer?
I don’t think there is a structured way of reporting but the variable used by pathology is: LVSI present Uncommon, but reported as extensive LVSI (LVSI present both within and outside main tumor) Dermal lymphatic invasion
What is the optimal time to wait prior to surgery following radiation therapy for rectal cancer to maximize the pathologic complete response rate?
Great question- and this is an even more interesting question in the era of TNT, with variables of SC vs LC RT and sequencing of induction vs consolidation chemotherapy. Especially with the question of—how do we best maximize the chance of a pathCR? I think starting with that question is the first s...
In a patient with a mediastinal recurrence following lobectomy for early stage NSCLC, what would be your treatment volume?
In a patient who develops an isolated failure in a regional nodal site after surgery, I would treat in a manner similar to inoperable stage III NSCLC (concurrent chemotherapy and radiation therapy). Under most circumstances, I would include some "selective" elective nodal coverage based on a number ...
What dose and fractionation would you use for Kaposi’s sarcoma of the tonsil post op?
36 Gy/2 Gy X 18 to the surgical bed with IGRT and 40 Gy/20 to the positive margin area based on pre-op images with 10 mm margin for CTV expansion and 3-5 mm with CTV-PTV expansion. Quéro et al., PMID 35454820 Cihan, PMID 29383006
What dose are you routinely using for adjuvant RT for intermediate risk p16+ SCC of the OPX s/p TORS?
It's still just a phase II trial. Even the authors state in the introduction that their primary objectives were to demonstrate the feasibility of a prospective multi-institutional study of TOS for HPV+ OPC followed by risk-adjusted adjuvant therapy and that a planned phase III trial is in developmen...
Would you offer definitive radiation therapy for extracranial schwannoma located in the neck?
Yes. 50.4 Gy/28 fractions
When treating resected brain metastases with post-op SRS, what dose, fractionation and PTV margin do you use for large (>3 cm) cavities?
I would refer you to Scott Soltys' work:Choi et al., PMID 22652105Soltys et al., PMID 17881139This is also useful:Brennan et al., PMID 24331659