Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there any situations where you would specifically not use IMRT/VMAT to treat post-operative gynecologic malignancies?
The short answer is no. Although,taking into account internal organ motion - ie., bladder and rectum - is very important to define the correct ITV and PTV. Our new atlas will be available soon and will build on our previous publication.
Does the better prognosis associated with p16+ H&N cancers relate only to patients who are treated with RT +/- chemo?
The good prognosis of HPV-related OPC pts is observed also in surgical series. Surprisingly, series of TORS find no ststistically differences in TORS for early stage HPV(+) or (-) pts (Cohen MA, Weisndtein Gs et al, Head and Neck 2011), and it is possible that surgical resection of HPV(-) cancers gr...
Given the results of the recently published GETUG 16 randomized trial, should all men undergoing salvage prostate radiotherapy receive concurrent hormone therapy?
I'm not surprised to see this question posted on The Mednet. GETUG 16 was recently published (Lancet Oncol. 2016 May 6.) and provides additional prospective information regarding the role of ADT in the managment of salvage prostatectomy cases. Not to nitpick over the article excessively, but I did n...
What dose would be appropriate for large intra-abdominal or retroperitoneal sarcomas that are unresectable?
I think this is a very difficult question to address. If medically inoperable, the nature of the inoperability is essential and the comorbidities would need to be balanced against the potential morbidity of sarcoma progression (and thus grade matters) and treatment. If surgically inoperable, I would...
What healthcare blogs should radiation oncologists be reading?
Weblogs, more commonly called blogs, come in many forms. The best ones to follow depend upon your interests and which platforms you like best. Twitter is a micro-blogging platform. So for brevity I'll focus on 'traditional' blog formats using Blogger, Wordpress or similar software. General Healthcar...
What is the absolute maximum lung V20 that you will accept for patients undergoing chemoradiation for locally advanced lung cancer?
Here's how I start with those high V20 plans: I usually do a 4D CT, then make ITVs. I use a 7mm CTV for primary lung and a 3 mm CTV for nodal disease. Using a Boolean function it's easy to put them together for a CTV6000 and then expand that by 5 mm. We do daily CBCT for alignment and I think 5 mm i...
What surveillance imaging is appropriate after spine SBRT?
All of us have our own formulas. I tend to see patients about 2 months right after spine SBRT, then every 3-4 months thereafter. While most patients I continue with every 4 month follow up beyond two years, there are times that I space that out to every 6 months depending on the clinical circumstanc...
For a patient with inflammatory breast cancer after standard initial systemic therapy with only a partial response, do you recommend more systemic therapy, pre-operative radiation, or proceed to modified radical mastectomy?
If the disease is operable with a partial response, then we proceed with surgery. Otherwise, we try a different chemo regimen and sometimes preoperative RT to make it operable.
Do you offer hypofractionated accelerated whole breast radiation therapy for women receiving trastuzumab during RT, particularly those with left sided primaries?
In the modern era for breast RT the radiation field should not be transversing through heart (a conformal block, the prone position or DIBH technique can help prevent radiation to the heart) and with one of these techniques mean heart dose is 1 to 2 Gy (most of this dose comes from scatter or transm...
When should intermittent androgen deprivation vs continuous androgen deprivation be used for the treatment of prostate cancer?
I think the question posed and the patient example are really 2 different questions. To address the title question, let me call your attention to a recent article in the JCO 34: 280-5, 2016, and an accompanying editorial, which review this issue in detail. The authors point out that there are signif...