Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What marginal SRS dose do you prescribe for brain metastases 2 cm or smaller?
Many gamma knife centers have gotten away from the 24 Gy marginal dose based on rates of treatment related imaging changes/radiation necrosis. At Yale, we use 22 Gy as our "top" dose. We have an ongoing prospective phase I/II trial investigating dose selection for gamma knife based on a grid of dose...
Do you recommend concurrent cisplatin and gemcitabine with radiotherapy for unresectable vulvar cancer, as described in GOG-279?
We are still doing weekly cisplatinum with a higher dose of RT as there is concern about additional morbidity with the addition of gemzar. Richman et al., PMID 32981696
Is a close but negative for margin (<5 mm) an indication for adjuvant radiation in oral cavity squamous cell carcinoma?
I treat a close margin in the high-risk post-op PTV (66Gy) but I do not ask med onc to add chemotherapy unless the margin is a true positive.
Is there a role for radiation therapy in the management of unresectable solid papillary cystic tumor of the pancreas?
Actually, as it happens, I am currently treating a large solid pseudopapillary neoplasm of the pancreas. It happens to be the first I have ever treated. You are correct. I could find 1 case report from the 1980s where 2D radiation was used and the treatment was "effective". When I presented the case...
Is SRS or 3-5 fraction SRT appropriate for cystic brain metastases?
Optimal management of large cystic metastatic brain lesions remains an area of high controversy and debate. One approach would be to aspirate the cyst followed by radiosurgery. Pan and colleagues1 reported that tumors with a large cystic component (>10 ml) did not appear to be effectively controlled...
How would you treat an unresectable eccrine carcinoma of the skin of the face?
I would prescribe 63 Gy in 35 fractions 250 kvp with a Thoreaus filter and lead collimation on the skin and elective neck RT with 6 MV using an AP field. If it is too extensive for orthovoltage, I would recommend IMRT or protons depending on location and extent.
What are your top takeaways in GI Cancers from ASTRO 2024?
Neoadjuvant Chemoradiation (CROSS) vs. Perioperative Chemotherapy (FLOT) in Esophageal Adenocarcinoma (EAC): ESOPEC – a Randomised Controlled Prospective Multicentre Phase III Trial published in issue: October 01, 2024 S6 Has now changed the standard of care for adenoCA of the esophagus. CROSS appro...
When do you recommend endocrine therapy for chemoprevention in women with high-risk benign breast lesions?
Women with atypical hyperplasia or lobular carcinoma in situ have a 4-10 fold increase in breast cancer risk. In the randomized controlled trials of endocrine therapy for chemoprevention for 5 years, this subset of women with high-risk benign breast lesions had up to a 60-70% relative risk reduction...
In the case of a thoracic esophageal cancer that will require extensive volume coverage, >2/3 of the esophagus, do you prophalactically prescribe a feeding tube or observe?
I am not a big fan of stents and working with the University of Utah team we published on this issue (Francis et al., IJROBP 2017). For a series of 103 consecutive patients treated with definitive or neoadjuvant chemoradiation (CRT), of whom 28 had a stent in place during the chemoRT, we found that ...
Does pathologic complete response impact your selection criteria for tumor bed boost of breast cancer patients' status post neoadjuvant chemotherapy and breast-conserving surgery?
I have not used response, including pathologic complete response, as a reason to change my criteria for tumor bed boost following neoadjuvant chemotherapy. I typically will boost patients that meet at least one of the following criteria: age <50, ER-, cT3, grade 3, LVSI.