Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you sequence treatment for a patient following R2 resection of a large extremity leiomyosarcoma who has small lung nodules concerning for metastatic disease, but not yet biopsy proven?
In general R2 resection is not good news. I would first clarify with the surgeon, the barriers to a re-resection. If re-resection is feasible, then perhaps that should be attempted first. This patient is at high risk for local relapse, which ultimately leads to a poor quality of life. If the lung no...
Would you ever considering de-escalating therapy in any way for women with inflammatory breast cancer who had a complete pathologic response after surgery?
The first two options are reasonable but would not reduce the volume of treatment and would still consider for boost around the scar area even with hypofractionation.
Is there a role for consolidative definitive radiation therapy for metastatic rectal adenocarcinoma with good response to systemic therapy (patient is not symptomatic)?
Yes there definitely is. Patients with colorectal cancer are living much longer with aggressive treatment of metastatic disease and active chemotherapy. "Definitive" CXRT is really a neoadjuvant/palliative dose, 50.4 Gy in 28fx is the standard with 3D CRT. We would expect a 30% cCR and if that happe...
For linac based fractionated radiosurgery (5 fx) to a brainstem metastasis, is there a dose constraint for normal brainstem outside of the target volume?
More data are needed on brainstem tolerance for multi-fraction SRS. I use the AAPM TG101 suggested constraints of <0.5 cc >23 Gy and <0.035 cc >31 Gy. For metastases, one could certainly consider exceeding these constraints, as tumor recurrence would result in similar (if not worse) potential functi...
Would you offer post-operative radiation for a glomus tumor of the spine following decompressive laminectomy and incomplete resection?
[68Ga]-DOTATATE PET/CT has demonstrated excellent diagnostic value in the localization of SDHx-related and sporadic head and neck paragangliomas. Significantly more lesions were identified on [68Ga]-DOTATATE PET/CT compared to all other functional and anatomical imaging modalities Janssen et al., PM...
Is ASTRO's recommendation to avoid whole brain radiotherapy following SRS for limited brain metastases practical for patients treated in the community setting?
Agree, YES! But, can I elaborate? :)No evidence has ever indicated any benefit more than local/elsewhere brain control for WBRT. The addition of WBRT to surgery didn't change overall survival, and enough retrospective data indicates cognitive side effects. Patchell's trial used 50.4 Gy in 1.8 Gy fra...
Does radiation offer a benefit for knuckle pads due to Dupuytren's?
Knuckle pads have similar histology to Dupuytren's and may be called dorsal Dupuytren's nodules or Garrod's disease (PMID:31184950). Radiotherapy is effective for early-stage Dupuytren's and 10 patients with Garrod's disease were irradiated in the large German radiotherapy study, but results for tha...
How do you typically prescribe dose to a PTV for standard IMRT plans?
Each PTV has three constraints: >/= 95% of PTV receives 100% of RX dose Max hot spot </=110% >/=99% of PTV receives >/= 93% of Rx Dose
How would you approach patients with primary cardiac sarcomas for adjuvant systemic treatment?
Majority of these primary cardiac sarcomas tend to be angiosarcomas or UPS-variants. They inherently have a poor prognosis with high risk of metastases and death. Adjuvant XRT is generally difficult in this location. These also generally affect young individuals with o/w good PS/organ function. So w...
In what situations (if any) would you recommend ENI for a low grade parotid mucoepidermoid carcinoma?
Not sure if I understand the question correctly but I will give the best answer I can. There aren’t many reasons to treat low-grade parotid mucoep. If you’re treating for positive margins only, I wouldn’t do ENI. If you’re treating for PNI, cover nerves to skull base. If there are positive nodes, tr...