Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose and fractionation do you use for gynecomastia prophylaxis?
As I answered on a previous thread to a question that was similarly posed, philosophically I would prefer electrons (less integral dose/more focused - IMHO) as opposed to photons. In terms of dose, it seem these days less is better with single fraction especially. Hence, the NICE (European) guidelin...
How do you approach management of limited stage SCLC in a patient with idiopathic pulmonary fibrosis?
I've seen a few patients with IPF and small cell. The concern is always that these patients have an underlying pro-inflammatory lung condition that makes them more prone to pneumonitis. My preference in this specific group is to give and complete chemotherapy first and then restage the patient. Sinc...
How would you approach an early stage p16+ SCC of the tonsil s/p TORS and neck dissection with initial positive margins but then negative on re-resection?
Postop RT
Is day 43 cisplatin 100mg/m2 needed after completion of RT in case of a delay related to neutropenia for locally advanced head and neck cancer?
Based on the retrospective post hoc analysis from RTOG 0129, two cycles of HD cisplatin in the accelerated fraction radiation treatment arm and two cycles of HD cisplatin in the standard fraction radiation arm were equivalent to 3 cycles of HD cisplatin when administered with RT. (Nguyen-Tan et al.,...
Would you dose escalate for prostate cancer extending to the penile bulb, towards the urethra, and close to anorectal junction?
I agree with Dr. @Dr. First Last's inquiry regarding the definition of "dose escalation" in this setting. In my mind, the question relates not so much to dose as to target coverage. I would not alter dosing on this basis but would carefully assess the appropriate target with pelvic MRI and PSMA PET-...
How do you approach treatment of sub-total resected ZFTA fusion ependymoma after radiation therapy in a young adult?
Thank you for asking.ACNS0831 has shown that there is no benefit of adjuvant chemotherapy in patients with incomplete resection. This was based on a comparison between ACNS0121 where patients did not receive any chemo after XRT and ACNS0831 where all patients with residual received adjuvant chemothe...
How long should one wait before biopsying a persistently palpable mass of early stage nodular lymphocte predominant Hodgkin lymphoma (NLPHL) after radiation?
There is no set time frame for biopsy. I will recommend a PET/CT 3 months post treatment before making a decision on biopsy . The sensitivity, specificity, PPV and NNP of PET in NLPHL is 99 - 100 % (Grellier et al. Eur. J. Nucl . Med. mol Imaging 2014 ).
Would you irradiate all borderline suspicious lymph node regions on PET/CT in stage IIA nodular lymphocyte predominant Hodgkin's lymphoma treated with ISRT alone?
ISRT fields for lymphocyte predominant HL when treating without chemotherapy should be more generous in the nodal chain region than if treated with chemotherapy. We conducted a survey of expert lymphoma radiation oncologists published in the IJROBP, which demonstrated some differences in opinion. Ho...
How do you approach delivering ISRT to nodular lymphocyte predominant Hodgkin Lymphoma that has responded on FDG-PET/CT after chemotherapy?
The therapeutic algorithm in stage >I lymphocyte predominant HL is extrapolated from data on classic HL. Thus, I would use the same algorithm as in HL when evaluating RT indication and dose. Omitting radiotherapy is safe, if a favorable response has been documented on PET-CT and the patient has rece...
What is the best treatment volume and dose for a marginal zone orbital lymphoma?
It would depend on the location- retrobulbar, conjunctival or lacrimal gland. Imaging, including MRI, helps in evaluating the site of origin and extent of involvement. Some advocate treating the entire orbit for all orbital lymphomas to be comprehensive, as the total dose is low, and this away we av...