Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider 50 Gy in 20 fractions for a primary head and neck malignancy in an elderly patient with poor KPS?
Yes
Is it acceptable to do IFRT rather than whole posterior fossa boost for high risk medulloblastoma?
Based on dosimetric patterns of failure and early pilot studies of tumor bed boost from the University of Michigan and Memorial Sloan Kettering, respectively, the recently completed ACNS0331 clinical trial randomized patients with average risk medulloblastoma to whole posterior fossa or tumor bed bo...
How do approach palliation of local symptoms in the setting of metastatic vulvar cancer?
If patient's PS status doesn't allow definitive treatment, for local palliation, you can treat 4 Gy x 5 and then reassess in 2-4 weeks for further treatment.
How would you approach treatment for a glioblastoma from a radiation standpoint that was initially thought to be a metastases and therefore treated with multiple courses of SRS over the past few years?
It appears that the patient was empirically treated with multiple SRS courses; then, presumably, the patient must have undergone a biopsy/resection which disclosed the true nature of the problem (GBM). Therefore, the question is, what is the appropriate postop treatment for this patient? There are s...
Do you account for prostate shrinkage during XRT if ADT is started concurrently?
This is a common question since we reported the study results, and a valid one for sure. Stay tuned for an even larger meta-analysis of many more RCTs that further dives into the oncologic superiority of adjuvant compared to neoadjuvant ADT. However, to your question, what about toxicity?Here are my...
How do you counsel patients who will undergo external beam radiation regarding complications with breast implants from previous breast augmentation?
The best experience any individual can offer is likely anecdotal. There is one paper from the Mayo Clinic, which supports that most women are able to maintain an acceptable cosmetic outcome (about 2/3rd) and that with further intervention (i.e., capsulotomy) that number increased to 89%. The cosmesi...
Would you offer any degree of hypofractionation with concurrent chemotherapy for NSCLC?
I typically wouldn't, given limited data. CALGB 31102 (phase 1 trial) looked into this and found the maximal tolerated dose (MTD) to be at 60 Gy in 24 fractions (i.e., 2.5 Gy/fx). There's another phase 1 trial from Wisconsin which showed similar results (i.e., 2.5 Gy/fx). With these results in mind,...
What RT dose would you use to treat a single site relapse of high risk multiple myeloma?
Depending on the KPS of the patient, it may be 20 Gy in 5 to 36 Gy in 20. Data (Oertel et al., PMID 30987659) support upwards of over 45 Gy, but that is in the de-novo situation. This is post-treatment/transplant and represents a treatment failure and likely palliation. A 2005 paper on this subject ...
Do you deliver prostate SBRT every other day or consecutively?
Morgan S et al just published Hypofractionated radiation therapy for localized prostate cancer: Executive summary of an ASTRO, ASCO, and AUA Evidence-Based Guideline. It's an article in press in PRO right now. Question KQ4C addresses this question of daily fractionation and in the summary they writ...
When is SBRT or hypofractionated radiation appropriate as adjuvant treatment for pancreatic cancer?
There may be a variety of opinions about this question. 33 Gy in 5 looks to be as least as good as 50.4 Gy in 28 in unresectable pancreatic cancer and has had some improved pathologic responses in borderline resectable pancreatic cancer in experienced hands (Hermann et al., PMID 25538019). However, ...