Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever recommend PCI for large cell neuroendocrine cancer of the lung?
No. There is no established benefit as there is not the propensity to brain failure nor reduction in brain relapse or improved survival. There is a reduction in brain relapse in other NSCLC, but without improved survival.
When treating the regional nodes, what factors cause you to treat the lower axilla?
The two most important factors in node positive patients when we consider in treating level 1 and 2 axilla is inadequate dissection (this includes pts with sentinel node bx only) and a high percentage positivity (50% or more node positive ) in patients with an adequate dissection (10 or more node ta...
When utilizing the Canadian Regimen of 4256cgy/16 fxn- what boost dose and fractionation are you using?
We typically use the START B regimen when boosting (267cGy x 15 fractions) + 200cGy x 5 for the boost.When not boosting, we use Canadian regimen (266cG7 x16 fractions = 4256cGy).
Does the upstaging of breast cancer based on grade and hormone receptor status in AJCC 8 change your treatment recommendations?
The new stage should not in and of itself change management as the data and studies remain unchanged. Thus, for triple negative cancers, I would continue to hypofractionate if intending to treat the breast alone. In cases where I would consider RNI based on the available data (MA20 and EORTC 22922),...
Should lymph nodes be treated with postop RT of undifferentiated pleomorphic sarcoma of the head and neck?
Although the odds of regional node mets are likely low, I would treat the regional nodes if, depending on location, it would not significantly increase toxicity. Which it probably would not.
When do you recommend involving neurosurgery in the planning of SRS cases?
We tend to get neurosurgeons involved for all of our radiosurgery cases. With respect to planning, this ranges from a cursory glance at the plan vs. more in depth involvement in contouring and planning (which would be the case for all AVM patients). Even if the plan is likely to be straight forward ...
Do you boost involved mesorectal nodes in node positive prostate cancer?
This is an interesting question which has been at least partially addressed here: https://www.themednet.org/question/431. We utilize a similar paradigm of neoadjuvant ADT followed by pelvic RT of 46-50 Gy to elective nodal targets. We then try to boost the grossly involved nodes to a similar dose as...
Do you try to cover the entire mastectomy scar with PMRT even if it crosses over midline to contralateral side?
I usually cover the entire mastectomy scar even if it extends to contralateral side. This usually happens in locally advanced cancer or medial quadrant disease. Sometimes I add a matching electron beam to cover the medial edge of scar if the tangential beam increases normal tissue dosimetry. Detaile...
Do you treat pelvic lymph nodes in patients with high-risk prostate cancer who refuse ADT?
The treatment of pelvic lymph nodes for prostate cancer indeed is a controversial issue. I do treat pelvic lymph nodes in high-risk patients in the absence of ADT even though I do not have a phase III study to support its use. My rationale for treatment of pelvic nodes comes from RTOG 75-06. This st...
In a male patient with a single inguinal node containing SCC, with no identifiable anal or penile lesions, what areas would you cover and to what dose?
This is a very interesting case.If one can draw some analogy, then this is similar to head and neck sqcc met to neck node with unknown primary site(s). The debate has been to treat only the neck vs tx neck + “potential primary sitesâ€. To minimize morbidity, I try to treat only the ipsilateral si...