Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat the seminal vesicles when using moderate hypofractionation for prostate cancer?
The question refers to moderate hypofractionation and I will begin by defining moderate hypofractionation. In my book moderate hypofractionation involves daily fractions of 2.4-4 Gy/day as opposed to 1.8-2 Gy/day which remains the norm in the United States. There are several prospective reports of m...
Is there a benefit to metastatic & primary site RT in RMS w/ persistent marrow disease?
While I agree with the response by Dr Ermoian, I believe the case is more complicated than simply irradiating the gross disease at the primary site. Overall survival and Progression Free Survival for Stage 4, Group IV RMS has not changed substantially over the past almost 5 decades, despite many suc...
What is your approach to a patient with an advanced stage diffuse large B-cell lymphoma treated with chemotherapy alone (with a PET CR) who then develops an isolated CNS relapse?
This is a challenging albeit relatively rare situation. First, I would make sure to complete systemic workup, including MRI of brain/spine, CSF cytology, and PET/CT. I would not consider radiosurgery even for a single brain lesion, as this is ultimately a more diffuse disease process. If patient has...
Do you ever offer repeat radiation for hepatobiliary cancers in cases of local recurrence after definitive external beam or SBRT?
I do offer repeat radiation for hepatobiliary cancer after definitive external beam or SBRT. The dose and fractionation really depends on the size of the recurrence, the status of the patient's liver disease e.g. Child Pugh status (CP), and its location in proximity to critical structures.If the les...
What fractionation do you use for consolidative chest RT in extensive stage SCLC?
3 Gy x 10 is arguably the standard of care.For patients with good performance status, and who do not have extensive disease outside of the thorax (which is clearly a judgment call), we consider 2.5 Gy x 20 with a 2 week break. This is a well-tolerated schedule with respect to esophagitis. For those ...
When treating two primary early stage lung cancers with SBRT, do you treat both at the same time or stage your treatment?
A completely non-clinical but nevertheless "real world" thought:If you deal with Evicore, the insurance pre-auth gatekeepers for many private insurances in the U.S. (BCBS e.g.), and they "catch wind" that you're not going to treat such a patient's lesions synchronously, it's highly likely they will ...
How does the finding of incidental proximal seminal vesicle invasion on mpMRI alter your recommendation for brachytherapy in a patient with prostate cancer who was initially a candidate?
An additional thought........... Regarding this question as well we need to be cautious about the word "incidental". Normally an "incidental" finding would be characterized as a patient who was undergoing a CT scan of the abdomen and pelvis for the workup of a high grade prostate cancer, for instanc...
What is the appropriate dose and volume for adjuvant treatment of a sigmoid colon adenocarcinoma adherent to the L5 vertebral body with a positive radial margin?
There is no firm data on this topic, but in general colon cancers are not that radiosensitive and for positive margins, with no other evidence of tumor, one should go to a high dose. Ideally, if you know from preoperative scans that the margin is likely to be close or positive I would recommend a pr...
How would you utilize adjuvant radiation therapy in a patient with a cutaneous spindle cell neoplasm of the scalp metastatic to the parotid gland?
A lot will depend upon how “total” the parotidectomy really was. If the deep lobe was resected and the facial nerve sacrificed with totally negative margins I would be content to utilize careful observation with no postoperative radiation therapy to the parotid bed. If only a superficial parotidecto...
Do you offer consolidative RT for patients with oligometastatic NSCLC who initially presented with a malignant pleural effusion?
You cited a very important trial. When its results were published I thought they were a real sockdolager to any continued wholesale radiotherapeutic nihilism towards asymptomatic M1 NSCLC patients. (I must admit, in training during years 1999-2003 I can't remember anyone using the word "oligometasta...