Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach muscle invasive bladder cancer in an elderly patient who cannot tolerate chemotherapy?
Although the ideal approach is chemoRT, if patient can't tolerate chemo (if cisplatinum is contraindiacted, 5FU amd MMC is an alternative), then RT to a definitive dose is a reasonable alternative. In the UK randomised study, the control arm of RT alone had about 50% LRC at 2 yrs. For patients with ...
Would you treat a muscle invasive urethral recurrence of bladder cancer with definitive chemoradiation?
Assuming that the urethral tumor is invasive of the prostatic stroma, there are multiple reasonable answers depending upon the patient's age and health status. Remember that stromal invasion is a bad sign and these patients are rarely cured. If the patient is young, but reluctant to consider cystopr...
For patients with low risk prostate cancer and with very large prostates (>80cc) with significant urinary irritative/obstructive symptoms at baseline, should a short course of neoadjuvant hormone therapy be used prior to EBRT to reduce the severity of urinary toxicity?
A not so straight-forward question, given the results of PIVOT that suggests the majority of low-risk prostate cancer pts don't benefit from radical treatment, and the REDEEM trial that explored the value of dutasteride in low-risk patients. One thing is clear, though, which is many pts have signifi...
What is your practice regarding axillary isolated recurrence after surgery when a patient received previous whole breast radiation?
I agree with @Dr. First Last on both counts. In the case of a deep, isolated, axillary recurrence, we start with NeoCT (based on the CALOR Trial data).Now, let's assume the patient has had prior comprehensive radiotherapy (breast and nodal), and now has smaller, but persistent isolated axillary dise...
Is there a role for prophylactic cranial irradiation in non-lung neuroendocrine carcinoma?
I think series with other sites are too small for any meaningful conclusion. The limited literature for small cell cervical cancer has not shown a high incidence of isolated brain metastases, but rather it has shown that it is usually part of metastases to other sites with lung being one of them. Fo...
What are your preferred dose/fractionation options for treatment of hemoptysis related to central lung metastasis?
50 Gy in 5 fractions every other day with SBRT.
When should SBRT be preferred in operative patients who cannot undergo a lobectomy?
Numerous retrospective studies have examined clinical outcomes between SBRT and surgery using a variety of different statistical tests- propensity analyses, matched-pair comparisons, multivariable analyses, and so forth. Collectively, these studies report conflicting results. No randomized data with...
For patients with brain tumors without a history of seizure, what is your policy on driving?
There is no standard in the United States.We have no written policy. However, if there is clear neurocognitive impairment or there are clinical findings that can impair one's driving ability, I report to the state with a form from the Driver License Bureau that is filled out and then the DMV perform...
Do you recommend adjuvant chemoradiation for T2N0 gastric adenocarcinoma?
In general, we do not recommend adjuvant RT for T2N0 gastric adenocarcinomas unless other adverse factors were present. The long term results of the INT-0116 trial stated patients were T3-4 or node positive, but the initial report says stages IB-IV. Notably, the studied allowed T1N1 but not T2N0. Al...
Given the MA20 results, do you consider CW plus SCV or even regional nodal radiation postmastectomy for pT3N0 with high risk features?
I would certainly recommend PMRT for T3N0 with high-risk features (LVI, grade III, etc.). Actually, even before the MA 20 data is available, T3N) with LVI has a higher risk for LF as demonstrated in one of our papers (Floyd et al ). To avoid PMRT for T3N0, there should be no high-risk features (no g...