Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is SBRT an appropriate treatment for recurrent and unresectable spinal ependymoma?
Data in the literature based on Anca Grosu's work on re-irradiaiton of spinal cord show that the cumulative dose to the spinal cord can go up to a nominal BED (alpha-beta ratio of 2 and 2 Gy per fx equivalent) of 60-68 Gy without a significant risk of radiaiton myelopathy. All those patients were tr...
Are there situations in which elective nodal volumes may be reduced for T1/T2N0 anal SCC?
I have treated several elderly patients with small tumors using this low dose, limited field regimen. All did well. Involved-Field, Low-Dose Chemoradiotherapy for Early-Stage Anal Carcinoma Paul Hatfield, M.D., Ph.D., F.R.C.R., Rachel Cooper, M.D., M.Sc., F.R.C.R., David Sebag-Montefiore, M.D., F....
In patients who are medically poor surgical candidates, what are the treatment options available for bulbomembranous urethral cancer?
The evidence is thin, but these patients may be treated by chemo-radiation. Whether they are urothelial cancer or squamous cell carcinoma the aim would be to get in a worthwhile radiation dose, say 65-70Gy, with reasonable sensitizing chemotherapy if they have the kidneys to tolerate it. Sometimes t...
Do you routinely boost focally positive margins after preoperative 50 Gy and surgery in patients with extremity sarcomas?
Even though it was done in the Canadian randomized study comparing pre operative vs. post operative RT, retrospective data suggest hows no additional benefit with this intervention. This is likely because dose of 16 Gy would not be sufficient for residual disease. Even though it is not relevant in t...
How do you minimize skin toxicity in patients who have a significant amount of breast tissue contacting the couch during prone breast radiotherapy?
In our center, we treat roughly 60% of patients post lumpectomy in the prone position. Larger volume breasts treated in the prone position do touch the treatment table requiring care that this position is reliably reproduced daily. In our experience we do not see additional acute or late toxicity wh...
Should consolidative RT for extensive stage SCLC be given before, after, or concurrently with PCI?
Great question, and to my knowledge there's not a lot of data to guide this so I dont think there's a wrong answer.Before the CREST trial, my practice was to do PCI first, because I felt that the evidence for an OS benefit was much stronger, and it was therefore more improtant to get this completed ...
Would you consider SBRT for an inoperable T1-T2 N0 SCLC?
The concept of using SBRT in the setting of inoperable early-stage node negative small cell lung cancer (SCLC) is interesting and replicates the concept of SBRT as a surgical surrogate. In other words, SBRT is used to manage the primary lesion, as with early-stage non-small cell lung cancer (NSCLC)....
What dose/fractionation regimen do you use for the moderately accelerated, hypofractionated treatment of localized prostate cancer?
I use 70 Gy in 28 fractions. Rationale in brief below-Tested and proven to be non-inferior in RTOG 0415Less valid but important; we have been using this regimen at the Durham VA for nearly a decade.It is hard to be dogmatic; several regimens have been described in the literature but only two have be...
What RT fields should be used to treat a triple negative breast cancer with biopsy positive lymph nodes and a pCR to neoadjuvant chemotherapy?
Practice patterns after NAC remain highly variable with no clear accepted standard particularly when there is a complete pathologic response (See Haffty et al. Red Journal 2016). While B51 may answer this question the jury will be out for a long time. Clearly enrollment in B51 is the ideal approach....
Should adjuvant CRT be considered in gastric cancer patients who received pre-op chemo based on the recent results of the CRITICS trial?
There are many nuances here, but CRITICS suggests that there is little if any benefit to the routine use of postoperative chemoRT, in addition to pre- and post-op chemo, in resected gastric cancer patients who undergo a D2 dissection. The only scenario where I really consider postop CRT to be strong...