Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend post-operative radiation therapy for gastric cancer after pre-operative chemotherapy when there is no pathologic response to chemotherapy?
There is no level one evidence to support such a recommendation. One could argue this point either way. The counterargument is that poor response to chemotherapy predicts poor outcomes in gastroesopheal cancer and a local therapy will not change that. That is certainly the case for GEJ ACA who all g...
How would you treat a patient with a solitary prostate cancer metastases in the mandible?
This would be a very unusual situation, as metastases to the mandible generally occur late in the course of the disease. I would want to be as certain as possible that this really represents prostate cancer, and would get a biopsy. The biopsy not only would confirm the diagnosis, but also permit you...
How, if at all, has the new DAHANCA H&N contouring guidelines changed how you delineate low dose CTV (CTV-P2) for head and neck cancer primaries?
I think it is important to keep anatomical boundaries for head and neck cancer. To depart from that is problematic for the primary disease site. My subclinical region always takes into account the anatomical likely site of spread. The 5 by 5 rule that the consensus guideline referenced is an old sch...
Would you add elective nodal radiation for high-grade myoepithelial carcinoma of the hard palate in addition to adjuvant radiation of the post-operative bed?
Yes
What dose objectives and constraints do you use for hypofractionateed whole breast irradiation?
The most important goal is dose homogeneity. We aim for V110 (volume of breast getting 110% of prescribed dose) to be zero and V105 to be less than 10% with no V105 in the inframammary or areolar regions. For the heart, we aim for a mean dose 1-2 Gy with no beam going through heart so that the only ...
Would you recommend PMRT in a male patient with a T2N0 breast cancer?
In the absence of strong data for men, typically the adjuvant recommendations are extrapolated from the women's literature and node positive patients appear to benefit from PMRT. This SEER analysis is the most robust dataset published, thus far. N0 patients do not appear to benefit, so unless this p...
Would you treat a patient with definitive local XRT without systemic therapy if he/she presents with pathology showing a PTCL NOS from a small (1.5 cm) lesion of the skin of the chin?
For background, there are several T-cell primary cutaneous lymphomas. Several are treated routinely with radiation therapy alone, including primary cutaneous anaplastic large cell lymphoma (ALCL) and primary cutaneous CD4 positive small/medium T-cell lymphoma. Other T-cell primary cutaneous lymphoma...
What treatment do you recommend for patients with Siewert III gastroesophageal junction cancer with periesophageal or mediastinal lymph node involvement beyond what is considered regional for gastric cancer?
Patients with non-regional lymph node metastaseshave stage IV disease by definition and should be treated with palliative chemotherapy. There is no defined role for chemoradiation in this setting. However, in rare instances (e.g. young patient with excellent functional status and minimal non-regiona...
How would you manage a short-interval (0-3 months) failure in the untreated para-aortic region after definitive treatment of locally advanced cervical cancer?
The current paraortic disease could perhaps be an area near the edge of the prior pelvic XRT filed. Since this is the only area of disease now and given short 3 month interval, it is reasonable to give CHEMORADIATION AND TRY TO BOOST THE GROSS DISEASE.
What are your radiotherapy recommendations for a unilateral primary intraocular large B-cell lymphoma following high-dose methotrexate and rituximab?
Primary intraocular lymphoma is quite rare without standard treatment guidelines. As PCNSL often involves the globe, at initial diagnosis and/or at relapse, I view isolated intraocular disease as a subset of primary CNS lymphoma. HD-MTX regimens are typically utilized. As the disease is localized, c...