Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose constraint do you use for the brainstem for repeat cranial irradiation?
This depends on the disease I am treating, the interval time from initial radiation, prior radiation dose and fractionation. and whether or not I am re-irradiating by fractionated or radiosurgery. If this is a recurrent high grade glioma such that the brainstem was previously treated up to 54 to 60 ...
Is there evidence to suggest that SRS/SBRT for spine or bone metastases provides faster and more durable palliative relief or soft tissue decompression than a fractionated course?
This question has two components. One is faster pain relief from spine metastasis, and the other is epidural tumor control from SRS/SBRT over EBRT. The answer is yes, but there has been no direct comparison. RTOG 0631 asked similar question, and is closed meeting the accrual, waiting for the results...
How do you interpret and utilize PSA values in patients on dialysis?
There appears to be no clinically relevant impact on total serum PSA, whereas free PSA and % of total can be impacted in a membrane type-dependent manner to where % free PSA is of less utility for screening. Thus, total serum PSA seems reasonable to continue as marker of biochemical control post-tre...
Would you recommend post-operative radiation to an oligometastatic subcutaneous lesion resected with positive microscopic margins?
Probably not. I would need to know more specific details on the situation before making a recommendation.
When do you consider is too late after resection to offer adjuvant therapy for high grade osteosarcoma?
Regarding the time to resume chemotherapy post resection in osteosarcomas, I do not feel there is a strict cut-off time frame that would render one unlikely to benefit, however, there is well cited literature that shows that a delay of >21 days (3 weeks) leads to a higher risk of death (57%) compar...
Do you ever start immunotherapy along with WBRT in patients with PDL1 >50% metastatic NSCLC with significant visceral tumor burden in addition to symptomatic brain mets?
The general rule in the era of chemotherapy has been to hold concurrent therapy in the context of palliative radiation--in particular whole brain radiation--due to added side effects. These principles have shifted to some extent in the context of targeted therapies and checkpoint inhibitors as exper...
Is superficial underdosing of hypofractionated breast RT acceptable in patients with a large breast separation?
The 3D dose distribution and DVHs should be carefully reviewed for target volume coverage, particularly if the lumpectomy bed PTV is superficial. The most important consideration is adequate coverage (>/=95%) of the tissue included in the region of the lumpectomy bed PTV. Whole breast PTV coverage i...
What imaging schedule do you use for patients with SCLC who choose surveillance over immediate PCI?
In extensive stage patients that undergo surveillance rather than PCI, I've been using the follow up schedule that the Japanese PCI trial (www.ncbi.nlm.nih.gov/pubmed/28343976) used which was q3 month MRI for a year, then q6 month MRI up to year 2.
In the setting of head and neck cancer, if the pathology report shows extranodal extension (ECE), but the location of the node is uncertain, how do you define your boost volume?
It is important to discuss the case with the surgeon and your pathologist to get their input regarding the size and possible location of the node with ECE within the specimen. Ideally, every surgeon that's performing a neck dissection for possible cancer will orient the specimen and divide it into t...
For patients demonstrating ypN1 disease on SLNB following neoadjuvant chemotherapy, is it reasonable to proceed with regional RT in lieu of AxLND outside of the ALLIANCE A011202 trial?
Ideally these patients should go on the Alliance A011202 trial or have a full dissection as the current standard. AMAROS and other studies clearly have shown that radiation to the axilla is highly effective compared to axillary dissection for patients with a positive sentinel node at initial diagnos...