Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For ultracentral lung cancer abutting the heart, what dose constraints would you use for the heart and bronchus if using 10 fraction ultrahypofractionation?
The dose deviation from Timmerman for the heart is 60 Gy in 10 fractions. Now that they are published, I'd utilize the SUNSET constraints. Patients received 60 Gy/8 fractions (rather than the 10 fraction regimens questioned here) but the best data we have to extrapolate and use constraints that are ...
How would you approach adjuvant therapy for a patient with duodenal adenocarcinoma with ypT3 pN2 disease on Whipple resection after neoadjuvant FOLFOX x6?
I would offer postoperative chemoradiation. Duodenal primary cancers have more of a significant locoregional pattern of spread so logically, local control improvement could translate to a survival benefit.
How do you treat duodenal adenocarcinoma when using primary chemoradiation therapy?
We treat them the same as rectal cancer. Induction FOLFOX, followed by 50.4Gy in 28 with concurrent capecitabine. The responsiveness to these therapies is about the same, including cCR rate of 30% and ultimate LC without surgery 20%. There is no role for PET, we use CT CAP with contrast. The tumor +...
How do you approach treatment of brain metastases of varying sizes with SRS?
The UAB institutional paradigm has evolved to the following current practice patterns.Most patient's treatment plans are generated and delivered via HyperArc. Nearly all patients are treated on a Varian Edge with initial kv-kv, followed by CBCT/sim 6DOF alignment based on bony windowing with the VOI...
For patients with clinically node-positive prostate cancer, would you consider adding a brachytherapy boost to external beam radiation and ADT?
Absolutely not. Unless on a clinical trial.Not only are these patients excluded from every brachy trial, there is essentially zero retrospective data. Thus you have essentially no data that this will help the patient. However, what you know is that it will increase cost and increase toxicity.ASCENDE...
Would you modify your treatment approach for treating an HPV-positive head and neck cancer in a patient with symptomatic Sjogren's?
Patients with Sjögren’s syndrome have baseline xerostomia of variable severity. Management of Head and Neck cancer in this population depends on the location and stage of the primary. I would prefer to treat them with primary surgery if at all possible. If RT is necessary either as primary modality ...
Would you ever consider definitive thoracic RT with concurrent immunotherapy in Stage III NSCLC?
Generally speaking in my opinion, concurrent chemoradiation with a platinum drug doublet remains standard of care outside of clinical trials. Definitive chemoradiation in stage III lung cancer is considered a curative regimen despite the risks of local recurrence (around 30%) and distant mets. Bear ...
How would you manage a left sided triple negative breast cancer with a concurrent left sided locally advanced non-small cell lung cancer?
The presentation of two primary cancers that carry serious prognoses is very challenging. There are many variables at play here that could alter the initial therapeutic approach and ongoing treatment. Assuming this patient has a reasonable KPS, PFTs, and can undergo surgery, one way to start is neoa...
Would you offer adjuvant radiotherapy to a recurrent HPV-independent vulvar cancer located close to the anus, which was resected with very close (0.8 mm) margins?
I would favor RT and include the inguinal region as with local recurrence, there is about a 15% risk of nodal involvement.
How do you treat intact SCC of the subglottic larynx?
This is a very challenging subsite, for which most of us have less clinical experience than for glottic or supraglottic tumors, and for which the available published series are fewer and more heterogeneous.The most important recommendation I can make on this subject is to direct the reader to an out...