Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What SABR dose-fractionation would you use when treating an oligometastatic site in the femur or weight-bearing acetabulum?
This is a very good question. We only excluded femoral sites from COMET out of an abundance of caution, not because of any evidence suggesting fractures in this location.We were worried that a couple of fractures would not only cause harm, but would also end the trial, particularly as they can lead ...
How do you approach radiation therapy for a target volume adjacent to a WATCHMAN atrial appendage closure device?
The WATCHMAN is a non-electronic device so it does not carry the same concerns for device disruption for which we have dose limits (i.e. pacemaker, ICD, etc.). There could be a consideration of the impact of radiation dose on healing/tissue formation over the device in the period immediately after p...
What dose would you give for unresectable anaplastic thyroid carcinoma?
Palliation sometimes can be more complex than definitive treatment in head and neck, particularly when the patient does not have distant disease. Having trained at MDA, I have frequently used the Quad shot (14Gy/4fx, given with BID fx c 6h in between fx) (Corry et al Radiother Oncol, 2005) It is rel...
How do you approach the use of parathyroid hormone-related protein analog drugs in the setting of prior external beam radiation?
The concerns about prior external beam radiation are due to the independent increased risk of osteosarcoma associated with external beam radiation. The boxed warning associated with the PTH anabolic drugs WARNS that patients with prior radiation should not receive PTH anabolic drugs. (Note this is n...
How would you approach SCC of unknown primary, p16-, EBV-, metastatic to a large 5.5 cm level 2 neck node, if you suspect a cutaneous origin after clinical workup?
Surgery and postop RT to the ipsilateral parotid and neck
How would you treat a stage III lung cancer with N2 disease and a small synchronous contralateral lung primary?
Given that the patient has synchronous primary NSCLC's, I would treat each definitively. There is minimal data regarding this exact scenario but a couple of options are possible. One could include the contralateral lesion in the RT fields when treating with chemo/RT and durva. Alternatively, one cou...
For a patient with locally advanced lung cancer and mediastinal but not hilar involvement, would you electively treat the ipsilateral hilum?
As Dr. @Dr. First Last eludes, the lymphatic drainage pattern justifies buzzing the hilar basin. It's unclear if we need to prescribe a full (60 Gy) or microscopic dose (45-50 Gy). The hilar region often receives an incidental microscopic dose anyway due to dose spillage from the 60 Gy targets. But,...
What dose do you recommend for an oligometastatic bone metastasis involving the glenoid?
For a bone lesion close to a ball and socket joint, I tend to use 35 Gy in 5 fractions in order to decrease the risk of damage to the cartilage. I usually expand 5 mm from GTV to generate a CTV with trimming of the portions that go beyond the bone if no extraosseous extension. I also expand a 2-3 mm...
How would you approach an HPV+ retroperitoneal mass s/p resection involving the psoas/ureter, with uterus/cervix negative for any cancer?
When the PET and EUA are negative, I have treated HPV positive unknown primary with post-op or definitive chemo RT based on location. There is limited published data on HPV positive groin or pelvic nodes with occult primary. The last one I treated for unresectable RP mass had good response locally b...
What is the role of SBRT in recurrent oligometastatic ovarian cancer?
Ovarian granulosa cell tumor are not as chemo sensitive and respond more to local treatment and have long disease free interval and longer time to recur. Surgery where feasible and if not local treatment with fractionated IMRT or SBRT is reasonable based on location and extent of disease to prolong ...