Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a pt with cT2N0M0 SCC of the supraglottic larynx (good PS, swallowing function) with a bulky primary tumor?
The University of Florida data suggests that bulky supraglottic larynx cancer >6 cc have relatively poor local control following standard fractionated RT. Altered fractionated RT, specifically hyperfractionated, may improve the results. The question is how to weigh hyperfractionated RT vs concurrent...
Do you treat early-stage dupuytrens disease with radiotherapy?
Yes. Below are excellent references with long-term results and descriptions of technique. 1. Betz, N., Ott, O.J., Adamietz, B. et al. Radiotherapy in Early-Stage Dupuytren's Contracture: Long-term results after 13 years. Strahlenther Onkol (2010) 186: 82-90.2. Seegenschmiedt M.H., Keilholz L., Wielp...
In light of the AMAROS trial, how do you decide between ALND vs. axillary RT?
These clinical scenarios will be faced more often by radiation oncologists.In the old French and NSABP B4 data, the regional control rates between surgery and radiation were very similar for clinically node negative patients, but these studies did not gain much traction because chemotherapy decision...
Has there been an observed interaction between ACE inhibitors and development of angioedema in a block demarcated superficial radiation therapy treatment volume (ex. lip)?
ACE inhibitors are the leading cause of drug-induced edema in the US (ACE inhibitor-induced angioedema - UpToDate). It was likely not related to the radiotherapy.
How do you justify adjuvant radiotherapy in pancreatic cancer?
Even though it was flawed in every imaginal way, ESPAC1 had a high impact and made post-op chemoradiation experimental. Prior to that, radiation was not based on very much evidence. GITSG was a 40-patient positive study; the EORTC trial was negative. After the ESPAC1, the focus shifted to neoadjuvan...
Would you offer pelvic re-irradiation in the setting of locally recurrent anal cancer in the presacral region?
Re-irradiation is always tricky. I don't want to miss a chance to help someone, and I really don't want to hurt someone. With re-irradiation, the devil is in the details. If it is small, in a spot where symptomatic toxicity is less likely, and a long period of time has passed since the original chem...
If a patient with non-metastatic prostate cancer is found to have a BRCA mutation, should this influence treatment recommendations for local therapy?
While there are no randomized trials to address this question, one prospective, non-randomized study of BRCA2 carriers with localized prostate cancer suggested improved outcomes with lower relapse rates in men treated with radical prostatectomy as opposed to radiation therapy. See: Castro et al., Jo...
What is the role of postoperative radiation therapy after complete resection of a high grade spermatic cord sarcoma?
I agree with the previous answers to the extent that the role of radiation therapy in this disease entity is not established, as there is no hard data on which to base a decision. But I would recommend radiation therapy in this situation while providing the appropriate caveats to the patient as to t...
For unfavorable intermediate prostate cancer in elderly patients, would you consider radiation without ADT?
This is a great and highly clinically relevant question that I view has 4 important inter-related points.First, I will take the liberty of rephrasing the question as I believe the real question is... for a man with a good enough life expectancy to warrant curative intent RT, does age and comorbid co...
In which scenario would you prefer use of passive scatter proton therapy over intensity modulated proton therapy?
During my fellowship 5 years ago, the training I received was that passive scatter had sharper beam penumbra than pencil beam scanning, due to the use of a brass block (think like an electron cone) closer to the patient. However, I think that the final margin width or total volume treated is more im...