Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you give breast radiotherapy to a patient with a history of bilateral retinoblastoma?
I would certainly be concerned about it, especially if patient has been tested and is positive for hereditary RB. The risk of a secondary malignancy in the RT field would increase many fold, especially bone or soft tissue sarcoma. Although I have not treated anybody, I may consider the patient for p...
Is post-mastectomy RT recommended for patients who have a local failure after partial breast irradiation?
In general if a mastectomy was performed for an inbreast local relapse, whether the patient recieved partial or whole breast previously, or even no radiation, I would not offer PMRT unless there were specific risk factors indicating a need such as a diffuse relapase, dermal invasion, extensive lymph...
Would you use SBRT to treat a >5cm NSCLC with chest wall invasion in a medically inoperable patient?
This is a very relevant and interesting question as the patterns of practice and indications for lung SBRT continue to evolve. It also fits in nicely with two recent retrospective reviews we conducted at the Cleveland Clinic using our 10-year old lung SBRT data registry. Addressing the first compone...
Is there an age cutoff you use to determine when you will offer standard vs hypofractionated breast radiation in early stage breast cancer?
About 20% of patients in both START A and START B were under the age of 50, and these were huge trials. As such, I don't see a compelling reason not to treat younger women with hypofractionation. To put it another way, I don't think we have good reason to believe that schedules that are designed to ...
Would you offer adjuvant radiotherapy to a small low grade T1 adenoid cystic carcinoma of the minor salivary gland that was completely resected?
I can think of one ACC patient I have not irradiated postop in over 35 years. This would be the second. 3mm? Really? 3cm I would irradiate.
Should the incorporation of thoracic RT be standard in patients with extensive stage small cell lung cancer?
The jury is really still out on the issue of whether or not to add thoracic radiation therapy to prophylactic cranial irradiation (PCI) in patients with extensive-stage small cell lung cancer. The published data cited above, Slotman et al. in Lancet last Fall 2014, indicate that there may be an over...
Are there ever indications to include the inguinal nodes in the RT treatment field in a testicular seminoma?
I would not consider any situation as a definitive indication to treat inguinal region prophylactically for seminoma, unless the inguinals are involved.
What indicators have you found helpful in screening cases that would be appropriate for possible peer review in radiation oncology?
We have written a summary of this issue as it pertains to IMRT, but the concepts would apply to other aspects of external beam RT. Please see Moran et al, in Practical Radiation Oncology July–September, 2011 Volume 1, Issue 3, Pages 190–195. Table 2 in that document is a nice summary of what we cons...
What is the appropriate management of Stage 0 (testicular intratubular neoplasia) of the testicle?
For patients with ipsilateral TIN, usually one performs orchiectomy. This may be diagnosed as part of an infertility work up, as these patients often have primary infertility and atrophic testis. The issue of RT comes for patients with previous orchiectomy and then develop contralateral TIN. For the...
What is the best toxicity data to quote to patients for prostate IMRT vs nerve-sparing prostatectomy?
The surgery vs. RT question is a common one during a “2nd opinion†consultation with radiation oncology. More and more comparative data are being published regarding disease outcomes but many fewer exist regarding toxicity. I often hand out a copy of Sanda et al, NEJM 2008, which reports on qual...