Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage prostate cancer with isolated presacral nodal metastasis?
Unfortunately, we can't really use RTOG 0521 to guide us here, as men with involved nodes detected by imaging were excluded. Also, according to the AJCC 8th edition staging manual, pre-sacral nodal involvement would be considered N1 rather than M1a, so although this man is at high risk for subsequen...
Do you have any specific bowel constraints when treating patients with palliative radiation 3000/10?
When treating palliatively with 30 Gy/10 fx, I don't routinely use bowel constraints. In terms of max dose, I look to minimize hot spots but don't use specific volumetric or point doses.
Do you offer definitive radiotherapy for recurrent carcinoma in situ of oral cavity in a patient who is not a surgical candidate?
There are insufficient data to support such morbid treatment. Moreover, this population typically has field cancerization and will develop invasive disease over time, and RT should be "saved" for when it is clearly indicated.
What is the threshold for negative surgical margins in multifocal microinvasive carcinoma of the breast?
I think it is reasonable to forego re-excision in this case if the margin is focally (i.e. < 4 mm) less than 0.1 mm, and the patient proceeds with appropriate adjuvant therapies. Re-excision could be considered if the span of DCIS close to the margin is extensive. The panel who delivered the DCIS ma...
What is a safe time interval from completion of hormones and external beam radiation to TURP in patients who develop refractory obstruction?
Great question. Ordinarily, in my past experience, if a patient had real LUTS >14 AUA score that was not relieved with alpha blockers, and/or had a large median lobe, we would prefer the TURP be done upfront and / or chemical debulking with ADT too. In these instances, we found we had less LUTS then...
How do you approach nodal coverage in PORT for NSCLC with involved station 8?
My recommendation is to review pre-op image and discuss with the surgeon who did the operation. Station 8 is not routinely sampled or dissected for NSCLC. I don't recommend to cover GEJ routinely due to toxicity.
How do you approach a case of nasopharyngeal adenoid cystic carcinoma with neck node unilaeral involvement?
ACCs could spread to the lymph nodes on occasion. This probability increases when they arise from minor salivary glands located in regions rich in lymphatic drainage such as the pharynx. If a patient were to present with node positive disease, I would treat the bilateral neck lymph nodes with an ele...
What factors do you consider when interpreting post treatment PET Deauville scores for patients treated with chemotherapy for classical Hodgkin Lymphoma?
PET-CT interpretation using Deauville Criteria (5 point scale) provides a more objective and descriptive methodology than previous scoring systems. However, there are still numerous limitations and challenges and I suspect refined methods to report PET-CT responses will evolve in the future. I utili...
How would you approach a locally advanced, radioiodine naive papillary thyroid carcinoma not amenable to a non-morbid surgery?
In certain cases there may a be a potential benefit. We have an 87 year old male with significant co-morbidities that prevented him from being a surgical candidate. Stage 4 papillary thyroid cancer with 1.7 cm right thyroid primary, 2.5 cm RML lung mass and 5 cm right cervical neck mass that was ver...
Should special precautions be taken when treating oligometastatic disease in the sacrum or pelvis with SBRT in a patient with a long life expectancy?
There's so much good data now that if you can work it out (insurance, etc) it's worth doing. My suggestion is to do it, but paint within the lines, meaning don't use a dose that's poorly studied and 1) adhere to good quality dose constraints like TG101, and 2) consider the PTV coverage...in that ord...