Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For localized prostate cancer patients, do you routinely give antiandrogen therapy for patients receiving LHRH agonist therapy?
Although studies have given anti androgen for variable period of 4 weeks to 6 months, we use it only to suppress testosterone flare.
How long would a vulvar cancer s/p definitive chemoradiotherapy, how long should the lesion be followed for regression before initiating biopsy or salvage surgery?
There is no prospective data but our practice is to perform once the acute reactions subside, usually 6-8 weeks after chemo RT.
When do you recommend prone breast radiation?
If the plan is for whole breast radiotherapy without nodal treatment, I treat almost all women prone. The only women that are treated supine are those that have lump cavities that preclude the benefit of a prone plan (positioned posteriorly along chest wall, so tangents cut through lung/heart) or th...
Would you consider prone SBRT (with solid image guidance techniques) if bowel is lying on a target, for instance bowel surrounding an oligometastatic lymph node or next to a kidney tumor?
I have done this, but rarely do. Patient setup uncertainty tends to increase in the prone position, thereby increasing the required PTV margin. This may limit the anatomical benefit of performing treatment in the prone position. However, if it works there can be great value in moving a radiosensitiv...
How do you approach a patient with avascular necrosis and symptomatic bone met in the region?
In such a patient, I would want know, though not in this order: 1. Tumor type: aggressive v. non-aggressive 2. Does the ortho service think the patient is a surgical candidate for Total Hip Replacement? Post op scheme fractionation 10 or so fractions? If aggressive histo maybe 5 post op fractions. 3...
When do you consider upfront surgery for locally advanced (T4) sinonasal CA?
I usually favor upfront induction chemotherapy for the unresectable cases or if upfront surgery has the risk of unacceptable morbidity. We then evaluate the role of surgery based on histology. For most histologic sub-types of sino-nasal malignancy, we favor primary surgical resection (salivary gland...
What elective areas do you cover for a primary oropharynx SCC isolated to the pharyngeal wall?
In addition, you would also cover the entire retropharyngeal lymph node axis - jugular foramen down to hyoid, both medial/lateral nodes. If either side of neck is N+, can consider IB/V. And, then treat as you would other head and neck - GTV + CTV + PTV to high dose, intermediate risk can be higher ...
Are you concerned about fiducials shifting within the prostate during prostate IMRT?
I think that it is important to consider what type of on-board imaging is being utilized. If it is a CBCT, then there will be additional information that can be interrogated when determining how to adjust shifts. If it is a fiducial match protocol, then I think that it is important to keep abreast o...
When treating a patient definitively for high risk prostate cancer, how would you interpret the interval development of sclerotic bone lesions that appeared during neoadjuvant ADT?
It most likely reflects treated metastatic disease but can be very difficult to prove, as bx yield is low since it has been treated. Would not change management and complete planned treatment. Stampede also showed benefit of local RT for limited bone mets
Would you recommend EBRT/brachythrapy for any patients with stage III- IV uterine ca in light of GOG-258 data?
GOG-258 will certainly change management approach. The recurrence pattern between the two arms (higher distant mets in chemo RT arm and higher locoregional recurrence in chemo alone arm) suggests that sequencing of treatment may also matter. Our current approach is to have chemotherapy first and con...