Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In the modern era, what volume of involvement is considered limited stage SCLC?
The TNM staging system (7th ed.) for lung cancer, which is the standard by which small cell lung cancer should be now staged, includes contralateral hilar and supraclavicular nodal involvement under the N3 rubric, resulting in a global stage IIIB designation. Most oncologists would thus consider the...
Do you ever use altered fractionation in the postoperative setting for patients with head and neck SCC?
Yes. In these cases I plan a course of accelerated fractionation scheme. I do a BID treatment one day a week to deliver 6 fractions per week (instead of 5).
How soon after pelvic RT can a routine colonoscopy be completed?
I have had them get it done once acute side effects subside in 8 -12 weeks. I do inform them about avoiding rectal biopsy and informing endoscopist about it.
Aside from the number and volume of brain metastases, what factors do you consider when choosing between repeat WBRT or SRS in a patient who has received prior WBRT?
Given the toxcity of repeat whole brain, I typically reserve it for patients with recurrent disease in the brain who are on their way to hospice. Otherwise, I will treat with SRS. Having said that, I think factors (in addition to number and volume of brain mets) that are important to consider includ...
Under what circumstances do you offer post-operative spine SRS over standard EBRT?
We typically consider post op SBRT for previously irradiated lesions, radioresistant histologies (renal cell, melanoma, sarcoma, GI primaries, for example), or patients with good prognosis (oligometastatic for example). These patients will have excellent and durable tumor control, low risk of toxici...
When would you include uninvolved nodal stations when treating patients with locally advanced NSCLC with definitive CRT?
You bring up a good point. Sometimes there are 'at risk' nodes in locally-advanced NSCLC (LA-NSCLC) that may not be FDG-avid and sit between two or more masses that are FDG-avid or perhaps are enlarged but not FDG-avid. Judgement does come into play when contouring targets. For background, RTOG 0515...
Are the conformality constraints still important when organ at risk constraints are met for lung SBRT?
Conformality constraints required in some lung SBRT clinical trials served as useful treatment planning guides that obliged attention to reducing the exposure of adjacent normal lung tissue to high dose.I am unaware of data specifically validating any of the indices mentioned in the question as a pr...
In which Her2+ breast cancer patients would you recommend extended adjuvant therapy with neratinib?
The benefit is largely in estrogen receptor positive patients and the gains are modest. Although with extensive and extended anti-diarrheal medications the almost intractable diarrhea seen with this agent can be made tolerable. On the other hand, it would take a VERY motivated patient, probably with...
How do you simulate a patient with a large beard who needs a thermoplastic mask?
I just sim these patients as normal. I assume you're talking about a H&N Ca patient. I counsel these patients that radiation "shaves" their beard, eventually and sparsely/unattractively at that, so it's usually not a big deal to get someone to shave if you so desired it. Also, you can't predict if t...
Should density overrides for VMAT lung SBRT planning be utilized for small mobile tumors?
I don't think it's a huge issue to change it, but I/we don't usually do that. VMAT plans are very robust to density changes so I bet if you looked between the plans it would be a very subtle difference....like less than 5% if I had to guess. We don't do it that way because it's a bit of a cheat (or,...