Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there data to suggest that definitive chemoradiation to 70Gy vs. postoperative chemoradiation to 60 or 66Gy has any different clinically significant effects on long term swallowing function and other side effects of H&N cancer treatment?
There are no good comparisons. The surgical literature that focuses on TLM/TORS tries to make this claim, but if you look at modern IMRT series, G-tube rates are equivalent, and are in part dependent on T_stage, since a T4 pt is more likely than a T1 pt to get chronic dysphagia. There are also no co...
For early stage indolent NHL (low grade follicular, MALT) involving midline structures of the head and neck (ie base of tongue, soft palate) how do you apply the concepts of ISRT?
@Dr. First Last,I think your question is a good one and probably not one answerable by definitive data. However, the recent publication of the ILROG guidelines on extranodal disease (Yahalom et al, https://www.ncbi.nlm.nih.gov/pubmed/25863750) and bulk of available data I believe suggest that it’s o...
In what situations would a standard FDG PET/CT be useful in the evaluation of high risk prostate cancer?
Overall, my impression is that the use of FDG PET for this purpose is limited. If interested, below is my rationale as summarized in the Conclusion.As mentioned, PSMA PET/CT is considered by many to be the current best standard of care for the staging evaluation of high-risk prostate cancer, and it ...
Is there a standard spinal SBRT dose regimen for patients with "oligometastatic" disease being treated with curative intent?
The simple answer is NO - there is no standard spinal SBRT dose regimen for patients with oligometastatic disease. There are a number of publications that demonstrate very good tumor control using 18-24 Gy in a single fraction, as well as a variety of hypofractionated treatment schedules in a variet...
Would you ever omit or reduce prostate bed radiation in a post-prostatectomy patient who develops recurrence in pelvic LNs?
In STORM, which is a phase 2 study looking at elective nodal RT vs SBRT for nodal recurrence presented at ESTRO, local recurrence was 5% in the group that got prostate bed plus nodal RT vs. 14% in the group that received only SBRT to node suggesting benefit of treating prostate bed for nodal relapse...
Do you consider regional nodal irradiation for women with ER+ breast cancer with a single micrometastasis after lumpectomy and sentinel lymph node sampling?
The data suggest excellent regional control with any approach like no additional treatment (Z11 and IBCSG) or regional nodal RT (AMAROS). Our approach for majority of patients with micromets is to cover level 1 and 2 node in tangential beam ( unless tripe negative then may consider RNI)
Would you consider a patient with DLBCL to have CNS involvement if no brain lesion is seen on imaging, CSF flow cytometry is negative, but PCR is positive for MYD88 and KMT2D mutations?
Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma contained within the ventricles of the brain and the subarachnoid spaces of the cranium and spine. It is possible that cfDNA fragments containing MYD88 and KMT2D mutations may have found their way into the CSF and thereby detected by PCR techni...
Should we be performing sentinel lymph node biopsies for HR+ patients ≥70 years of age?
I do not think that the monarchE data for adjuvant abemaciclib warrants changing our standard practice around omission of SLNB for patients >/= 70 yo with low-risk HR+/HER2- tumors that are clinically node-negative, because adjuvant abemaciclib is largely only appropriate for higher risk tumors and ...
What dose and fractionation would you deliver to the sole of the foot in a patient with multifocal cutaneous DLBCL that is resistant to systemic therapy?
We need some more information here. Does multifocal mean the patient has multiple skin lesions? The diagnosis of cutaneous DLBCL is also somewhat ambiguous. Is this cutaneous DLBCL leg type, a specific entity in the WHO pathology classification, or perhaps the older WHO classification is being used ...
What do you consider to be the minimum technological requirements to safely deliver spine SBRT?
In the spirit of careful attention to detail, there are a number of ways to answer this question. I will draw from our early institutional experience to prove some guidance on minimal technologic requirements for safe spine SBRT. The key elements are 1. Accurate imaging for target and organs at risk...