Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a benefit to adjuvant chemotherapy for patients with a solitary liver metastasis from previously treated colorectal cancer?
I know this question was asked last year, but for the record: Mark makes some great points above, but I respectfully disagree on using irinotecan in the post-met/micrometastatic setting. I don't feel the Ychou study provides enough support for this practice since there was no significant improvement...
Is it appropriate to treat patients with limited metastases with whole brain radiotherapy and a concurrent simultaneous integrated boost?
We have not done it but there are studies showing feasibility and good results.http://www.ncbi.nlm.nih.gov/pubmed/24674004
Is there an effective treatment for severe radiation fibrosis of the skin after radiotherapy to the breast or other areas?
I have used this regimen occasionally with moderate success. Worth a try. Topical Vitamin E as well can help.
In patients who are HPV postive, and non-smokers who have a complete PET response to induction TPF at the primary site, would you still treat the primary site to full dose?
Descalating therapy in HPV+ H&N SCC is the subject of investigation in ongoing clinical trials. Some are investigating de-escalation through the systemic agent used concurrently with RT (cetuximab vs cisplatin), such as RTOG 1016. Others are looking into the reduction of RT dose based on response to...
Is there a role for radiation in the treatment of superficial, non-muscle-invasive bladder cancer?
The data from Germany looks good for high grade non muscle invasive disease with chemo RT. Based on this, RTOG also has a protocol for this subset. There is no randomised comparison to surgery, but compared to the published surgical data, it looks comparable: http://jco.ascopubs.org/content/24/15/23...
Can the elective target volume in nasopharyngeal cancer, as specified in RTOG 0615, be reduced if OARs do not meet constraints?
Always protect the brainstem, spinal cord, and chiasm and by that, there will be some compromise of the target. One should not change the target.
How do you effectively spare the medial RP nodes and superior constrictors when you contour the bilateral RP nodes and place a 3-5 mm CTV to PTV expansion?
If you use PTV margins of 3 mm (allowed if you check set-up imaging before each treatment and adjust for set-up deviations), and you mark the lateral RPN CTV in the triangular space between the carotid artery and the longus muscle, You will be able to spare the part of the constrictor which is betwe...
What factors would lead you to consider RT for men with Stage I seminoma?
I strongly agree that observation should be the first option for Stage I seminoma with normal postop markers. Since cure rate is near 100%, we should be looking for the least morbid managment strategy. I generally favor observation with an expectation that para-aortic relapses of less than 5 cm shou...
When deciding whether to include an IMN field in a PMRT case, what do you consider a "safe dose" to the heart that you are willing to accept?
I agree with @Dr. First Last about keeping the heart dose as low as possible. Aim for a mean heart dose of ≤ 4 Gy. I prioritize the heart dose constraint, especially in younger women, women with pre-exisiting cardiac conditions and those who have had cardiotoxic chemotherapy. This may sometimes requ...
When do you start temozolomide with RT for high grade glioma?
Thanks! Will be interesting to see the differing views. I was "brought up" in residency to believe that TMZ is a radiosensitizer, but have been thinking about it more closely; why an alkylator would synergize with RT seems increasingly unclear to me.Many people say it acts as radiosensitizer from cl...