Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In light of the cosmesis and toxicity outcomes of the RAPID trial, should external beam partial breast irradiation be avoided?
The results of RAPID trial does raise the concern about worse cosmetic results which may not have been captured by the CTCAE score used in the NSABP study and one should be very cautious in using this schedule outside the context of a clinical trial. Whether it was because of spillover dose to uninv...
With a head and neck squamous cell of of unknown primary, do you typically treat the larynx?
Not routinely unless the clinical picture really strongly points to the larynx/hypopharynx e.g. p16- and the only nodes or the largest nodes are in level 3-4. It goes without saying that there should be an extensive search process with experienced surgical and radiologic input to try to find the pri...
Is it safe to give localized palliative spinal radiation with concurrent intrathecal cytarabine? If so, do doses need to be adjusted?
In past cases, we have avoided doing this due to concerns of excessive toxicity.
What is the maximum V20 on ipsilateral lung that can be safely accepted for 3 or 4-field breast plans?
We routinely treat the IM nodes so my comments reflect this practice: 1. I shoot for a mean ipsilateral lung V20 below 35%. This is achievable in most, though not all, plans. 2. The biggest driver of ipsilateral lung V20 is the amount of lung in the SCV field. 3. While it is tempting to raise the ma...
Is there any data to support the use of hormone therapy with RT in the adjuvant post-prostatectomy setting?
Unfortunately, randomized data remains limited. Although pT3/N1 pts were included in RTOG 8531 (www.ncbi.nlm.nih.gov/pubmed/15817329), the majority of the pts included in this trial were treated with definitive radiation. At ASTRO 2011, Shipley et al reported the results of RTOG 9601 (www.redjournal...
What is your criteria for a prophylactic PEG tube in patients initiating head and neck radiotherapy?
We do not routinely insert prophylactic tubes to patients receiving bilateral neck RT concurrent with chemo, unless they are malnourished to start with. The outcome is a need to insert feeding tubes to 25-33% of these pts due to sig wt loss during chemo-RT. Thus, most pts do not need PEG. continuing...
What is a safe and efficacious fractionation to use when re-irradiating a recurrent GBM?
I am a fan of 6x5 to the T1post and 5x5 to the local FLAIR; this is extrapolating from MSK experience of 6x5 to the post-op cavity for resected brain mets.
What's the safest way to hypofractionate treatment for prostate cancer?
The longest published data is on 2.5 Gy to 70 Gy from the Cleveland Clinic.That being said, the three randomized trials which have been presented or published (Italian , MDA, And FCCC (published recently in JCO)) have not shown any superiority of hypofractionation over conventional fractionation. Ra...
Which patients with intermediate and high risk prostate cancer should not receive androgen deprivation therapy?
Based on randomized trials that didn't exclude patients with cardiac risk factors, an overall survival benefit has been observed for intermediate and high risk localized prostate cancer. Review of RTOG studies has not detected an increase in cardiovascular events. That said, appropriate management o...
Do you decrease the duration of hormones in a man with high risk prostate cancer and cardiac risk factors?
I do consider a shorter course of ADT in the setting of a patient with significant cardiac disease, but usually only after speaking with the patient's cardiologist to first determine if there may be other mitigating risk factors that are more readily modifiable. If the patient is older than 75 or ha...