Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a field size in which you would consider single fraction palliative radiation unsafe?
There is nothing to suggest a larger field size when treating multiple body levels increases the risk of complications with 8 Gy single fraction. Radiobiologically it is less dose to cord than 30 Gy in 10 fractions. We routinely use it. Only if a large GI volume gets treated small bowel or stomach) ...
What are the appropriate dose-fractionation schedules for patients being treated with EBRT as opposed to SRS for an acoustic neuroma?
While we can argue about SRS versus FSRT all day, I think the data is slightly more clear with fractionation schedules. At Thomas Jefferson, my previous institution, we favored fractionation to 46.8 Gy in 1.8 Gy fractions for patients with serviceable hearing as this regimen has shown excellent tumo...
Can close surveillance be used to manage an intracystic papillary carcinoma that is associated with a small amount of low grade DCIS?
Intracystic papillary carcinoma, although by nomenclature is carcinoma, it has a behiavior like low grade DCIS and occurs in elderrly. Our treatment principle is very simailr to what one would do for DCIS.
What is the best way to peer review radiation therapy treatment plans within a department/clinic?
The is no single best way. Each radiation facility has its own unique strengths and weaknesses that will differ based upon staffing, specialization, intradepartmental culture, IT integration. I have worked in six different practice settings, and no single process will work for all. Key principles to...
For definitive fractionated RT of meningioma (presumed) without biopsy is it always necessary to treat edema evident on MRI Flair sequence?
Edema with meningioma is a complex issue, but appears in the vast majority of cases not associated with cerebral invasion by meningothelial cells. Clearly meningiomas can on occasion be brain invasive. This is now carefully defined as a WHO 2016 grade II criterion, but edema has not been shown to be...
In what situations do you consider adjuvant radiation for ovarian cancer?
Our understanding of the role of RT in ovarian cancer has been evolving. In most cases, the role is at most palliative because most ovarian cancers (particularly serous cancers) are widely disseminated at presentation. However, there is a subset of patients whose disease remains locoregionally confi...
Which PET imaging modality, if any, is preferred to work up possible nodal involvement or local recurrence in prostate cancer?
In my view, better, more sensitive imaging will transform our management of prostate cancer. Soon, I believe, maybe very soon, we'll be able to detect small volume nodal metastases and small volume metastatic disease. How to manage patients with, say, a solitary, <1 cm lymph node seen on PET will be...
When do you use a rectal spacer in combination with radiotherapy for prostate cancer?
We have done this in a few patients with high risk of complications ( history of IBD) with LDR brachytherapy. The procedure as suggested is done at the end of brachytherapy to avoid interference with ultrasound imaging. The spacer increased the distance and helped decrease the dose to rectum signifi...
For early stage breast cancer patients, should lumpectomy + RT be recommended over mastectomy?
The cancer registry based studies and long term follow-up, in my mind, reassures that even with longer follow-up, lumpectomy plus RT is equivalent to mastectomy alone without RT, and not better. That being said, a subset of early stage patients who are managed with mastectomy alone may benefit from ...
What is your approach for an inoperable patient with epidural spinal cord compression who has previously received maximum spinal cord dose during a previous course of radiation therapy?
http://www.ncbi.nlm.nih.gov/pubmed/18642349This paper highlights motor outcome in patients who had reradiation for cord compression with cumulative BED less than 120 With no RT reacted cord injury. if patient is not a candidate for surgical decompression we have retreated with EBRT and more recently...