Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a valid hypofractionated regimen for postop cervical/endometrial cancers given COVID-19?
There are no good prospective series of hypofractionation for cervix and endometrial cancer in the curative setting.
Should neoadjuvant chemoradiation ever be considered in the a patient with high risk rectal cancer in the setting of active ulcerative colitis?
Yes, several studies (admittedly virtually all are single institution and retrospective) suggest the risks of toxicity from radiation in the setting of UC or Crohn's are not as high as many of us previously believed. I think it is prudent to discuss the potential risks of excess toxicity with the pa...
Would you consider definitive concurrent chemoradiation to a patient with muscle invasive bladder cancer and a history of distal/sigmoid ulcerative colitis?
Ulcerative colitis is a relative contraindication to radiotherapy, but not absolute, in my view. UC can have a spectrum of acuity as well, from distant/non-active to active-undertreatment. For many bladder cancer patients, radical cystectomy is the primary therapy +/- neoadjuvant or adjuvant chemoth...
Would you consider hypofractionated prostate treatment for a patient with well controlled ulcerative colitis?
We recently performed a systematic review of the safety of radiation therapy in patients with prostate cancer and a diagnosis of inflammatory bowel disease. Three studies, accounting for 42% of the evaluable patients, profiled the treatment of patients with hypofractionation (n = 5/8 in Vanneste et ...
What is the preferred dose and fractionation regimen for cutaneous squamous cell carcinoma of the thumb?
No level-1 evidence likely exists for this relatively rare scenario, so common oncologic sense applies here: If appendage-conserving wide local excision (WLE) can be offered, do it. Post-surgical adjuvant RT is indicated if surgical pathology shows high-risk features for loco-regional recurrence: i...
Would you consider modifying the dose for focal prostate boost to other fractionation schedules?
DELINEATE was a phase II trial from the NHS which was designed to evaluate the toxicity of a simultaneous integrated boost (SIB) to the mpMRI-defined dominant intraprostatic nodule (DIL) for two fractionation schedules: conventional fractionation (cohort A) and hypofractionation in 20 fractions (coh...
Do you add a margin when treating brain metastases with SRS?
This is debatable. We use the Gamma Knife Perfexion system (with Leksell head frame) and we do not add margins when treating brain metastases. Some institutions feel more comfortable using 1-2 mm margins when using a LINAC based SRS and mask for immobilization. However, some institutions also feel c...
What is your radiation dose/volume for adjuvant treatment of a clear cell odontogenic carcinoma of the mandible after segmental resection?
CCOC is a rare aggressive tumor for which case-report reviews suggest recurrence rates of 30-50% following surgical resection. I would approach this tumor like I would poorly diff. Sqcca: targets including the resection bed with generous CTV margins (66 Gy), levels IA&B and IIA, and a few centimeter...
Are there additional risks associated with PMRT for a patient with prior lympho-venous bypass surgery?
Based on FABREC, we do offer hypofractionation after reconstruction and focus on plan quality with dose homogeneity and very selective use of bolus. RT CHARM will further clarify. LV bypass helps to reduce lymphedema risk and we don’t change fractionation based on that. Conroy, Cancer Network 2023
Would you offer whole breast RT in an elderly patient with early stage breast cancer with EIC?
EIC in-and-of-itself would not drive me to offer RT given that CALGB 9343 likely included patients with this finding, among other high risk features. I would, however, consider the constellation of risk factors in trying to place this patient on the spectrum of CALGB9343 risk. For example, a patient...