Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When treating recurrent rectal cancer with re-irradiation using accelerated hyperfractionation (39-45 Gy at 1.2 or 1.5 Gy BID), what normal tissue constraints would you recommend for the bladder and bowel?
We have always been very careful about excluding the small bowel if it has been treated before. The initial experience from Mohuidin et al indicated that chronic diarrhea could happen if small bowel was treated. For this reason we have used smaller 3D treatment volumes but included the sciatic notch...
Would you consider SBRT for multiple bilateral lung primaries and/or a lung primary with metastases to multiple lobes?
This is a difficult situation. There is not a ton of information on SBRT for synchronous lung nodules. Ironically I'm on one of the articles (Owen et al. Radiation Oncology, 2015). We treated 60+ patients with multiple nodules but many of them were metachronus, which is a bit different situation. Si...
How have the results of RTOG 1112 influenced your opinion of Y90 and other IR ablative strategies vs SBRT for HCC not amenable to surgery?
My opinion has changed to a fact with RTOG/NRG 1112 (NCT01730937). RTOG/NRG 1112 now provides definitive evidence that treatment of the entire tumor with an adequate dose of radiation has a survival benefit in patients who are TACE refractory or have macrovascular invasion. The controversy now is wh...
When do you consider using ALK targeted systemic therapy in lieu of WBRT or SRS for patients with metastatic ALK-positive NSCLC?
The development of crizotinib in ALK positive patients led to incredible control rates systemically, but as is now well known, less ability to control CNS disease. When crizotinib was the sole FDA approved ALK directed therapy, this led to the concept of "treatment beyond progression" such that pati...
What is the evidence that there is a benefit to giving doses higher than 3060 cGy-3600 cGy in the elective treatment of uninvolved lymph nodes in the treatment of SCC of anal canal with chemoradiation?
The published data with dose varying from 30.6 to 45 Gy to uninvolved nodes has not shown any difference in regional control. The studies which did not treat the pelvis to an adequate volume or excluded inguinal region reported higher regional recurrence.
What goes into your decision making when deciding between superficial radiation and Mohs surgery for cutaneous squamous cell carcinoma of the head and neck?
When it comes down to deciding between surgical resection and definitive radiotherapy for well-differentiated, non-melanomatous skin malignancies, my simple rule of thumb is: While surgery may be the gold standard, whenever the post-operative cosmetic or functional sequelae are perceived to be poten...
How are you utilizing vibratory devices for reducing pain associated with injection or procedures?
Specifically for intra-articular/bursal/tenosynovial/carpal tunnel injections: Our office purchased the vibration distraction devices over a decade ago based upon the promising use from the pediatric literature. Our providers were underwhelmed with their use in our adult patients and we all stopped ...
Would you include the entire hardware as part of ISRT for a patient with Stage IE DLBCL of the distal femur treated with upfront prophylactic nailing for impending fracture, who had a CR to chemotherapy?
Quite uncommon to encounter such a patient, but based on data for non hematologic tumors, no. Treat just the involved site with a generous margin, the latter never precisely defined, but depends on the tolerance of surrounding normal tissue. Parenthetically, it's often difficult to determine a CR to...