Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In evaluating V20 for lung RT, how should the lung volume be defined?
Most of the published data is on both lungs minus PTV. QUANTEC accounts for all normal lung treated minus GTV, and this is what we favor now. There is a small difference in numbers between the two approaches. Attached is a link to a dosimetric study we did in this regard to this to quantify this dif...
Is there a role for anti PD-1/checkpoint inhibitors or other immunotherapies with radiation?
There's a lot of enthusiasm, and fairly little evidence so far. Driving the interest is the observation made over the past several decades, that radiation can induce an immunologic/abscopal response: that by treating one site of disease, a systemic response is initiated that results in responses in ...
For T4a bladder cancer only involving the prostatic stroma and no bladder involvement, what is your final cone-down volume?
For bladder tumors that are well localized, whether the tumor is well localized in one portion of the bladder or well localized by virtue of primarily prostatic involvement, it is appropriate to provide a tumor-focused cone-down volume assuming one can provide image guidance or otherwise ensure that...
What are your criteria for treating a patient with lung SBRT in the absence of a biopsy?
First I would say that there is no standard answer to this, and the crtieria are going to depend on your population and the experience of you and your colleagues.. The group at VU has published their experience treating "clincially diagnosed" early lung cancer with SBRT, and found that the outcomes ...
What is the evidence that we should do anything different in breast cancer patients with 1 to 3 nodes involved versus those with four or more nodes involved?
A careful read of the literature will demonstrate that there is nothing magical about the threshold as one moves from 3 to 4 involved nodes, that the risk of a local regional failure increases almost linearly with the number of positive nodes, and that the addition of postmastectomy radiation improv...
Do you advise patients to avoid deodorant during breast radiotherapy?
This I believe is oncolore, and it has been around for decades. When I was a resident, I was taught to specifically counsel breast patients not to use deodorant because it could increase skin toxicity, either due to the physical surface coating or due to the metals in most deodorants. There are 4 ra...
Do you recommend treating the chest-tube site or pleural biopsy tract in patients receiving RT for malignant pleural mesothelioma?
I'm not sure that there is yet a definitive answer to this question.in the UK we used to use 21Gy in 3# with electrons to the chest wall sites -anecdotally I don't recall anyone coming back at that time with local recurrence but many may not have lived long enough back then for us to see it.It might...
Would you recommend definitive local treatment of locally recurrent breast cancer with a positive contralateral axillary lymph node and no signs of distant metastasis?
Locally recurrent breast cancers are known to have aberrant nodal spread, including the contralateral axilla, because of previous axillary dissection and radiation. We treat these patients as locoregional disease with a combination of locoregional and systemic treatment. You do take previous treatme...
For which patients with localized prostate cancer is SBRT an alternate standard of care?
The ASTRO Policy says it best: ASTRO Policy Statement on SBRT for Prostate Cancer Many clinical studies supporting the efficacy and safety of SBRT in the treatment of prostate cancer have been published. At least one study has shown excellent five year biochemical control rates with very low rates o...
In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?
The GHSG HD16 randomized trial was recently reported at ASH (Abstract 925). Patients with early-stage, favorable HL (per GHSG criteria) were randomized to standard treatment (ABVD X 2 followed by 20 Gy of RT) or a PET-directed approach. If PET negative after 2 cycles (defined as Deauville 1-2), then...