Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For a MALT of the eyelid, do you treat the entire conjunctiva reflection as well, or just the eyelid?
can you clarify the question? Is the question whether to treat superior and inferior conjunctiva (eyelids) or whether to treat deeper and more laterally on either the sup or inf Eyelid?
Is pectoralis muscle invasion an indication for post-mastectomy radiation (PMRT) for an otherwise early stage, node negative breast cancer with clear margins?
In and of itself no. Given the inclusion of specific node negative patients in MA.20 and EORTC 22922 and small but significant DFS benefit in both, by extrapolation to mastectomy it behooves us to consider carefully the potential benefit of PMRT in node negative patients without over-treating. In re...
For localized esophageal cancer in patients with preexisting neuropathy, what do you use concurrently with radiation therapy?
I would probably start with low-dose carboplatin and paclitaxel as done in the CROSS trial, and monitor carefully for worsening neuropathy with weekly assessment. As the doses are low and the duration of therapy limited to only 5 weeks, we may not see much worsening. In CROSS, there was 15% neurotox...
How would you treat a patient with recurrent brain mets from small cell lung cancer who has already received previous whole brain radiotherapy (30 Gy in 10fx)?
We tend to treat these patients with stereotactic radiosurgery and will treat up to 10 lesions given prior whole brain radiation therapy. We know from studies, however, that despite radiosurgery, they tend to recur elsewhere in the brain and that the need for future SRS salvage is higher than with o...
Do you offer consolidative thoracic radiotherapy to patients with extensive stage SCLC who have a complete response to chemotherapy?
The CREST trial did not meet primary goal of improving one year survival, but it did improve 2 year OS. Looking at subset, achieving CR to chemo was an indicator of a group that "did not benefit". So the rest of the question (what volume, what dose etc) becomes irrelevant.
How long to do you wait after resection of GBM to start radiation?
This is a frequently asked question from patients and there are several large retrospective series examining the timing of adjuvant radiotherapy for glioblastoma. We looked at our own retrospective series https://www.ncbi.nlm.nih.gov/pubmed/26440447 and found that in general, starting radiotherapy w...
How does your approach to contouring change when treating pancreatic body/tail lesions vs head tumors in the postop setting?
For tail lesions, we cover the splenic hilum and for head lesions, we cover the porta.
When should single fraction SBRT be offered for peripheral NSCLC?
Based on the updated results of RTOG 0915 single fraction radiation to 34 Gy in 1 fraction is reasonable to offer to any patient with a peripheral stage I NSCLC < 5cm (limited single institution data from Germany and Japan shows safety and efficacy even for large lesions). While RTOG 0915 does inclu...
How do you manage a patient with gastric/GE junction carcinoma who has positive lymph nodes at resection after neoadjuvant chemotherapy?
So, we know from the review of the MAGIC study by Dr. Smyth that ypN+ tumors are associated with a worse prognosis than ypN0 tumors. However, there doesn't seem to be anything we can clearly do about it with standard options:1) Changing chemotherapy is not likely to be helpful. Phase III studies in ...
What is the maximum acceptable hot spot for hypofractionation breast?
We in our practice follow below guideline V110 of zero percent V105 less than 10 percent (accept up to 15) no V105 in IM fold and nipple areolar region Try to achieve above with FIF, mixed beams and if can't get above then tangential beam IMRT or prone positioning