Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there any hypofractionated RT regimens that could be considered in a post-op setting for extremity soft tissue sarcoma?
Especially in the age of COVID-19, this is a relevant question. Although there are certainly hypofractionated regimens studied and employed in the pre-op setting, e.g. 30 Gy in 5 fractions as published by the UCLA group, I'm not aware of any parallel data in the post-op setting.Thus if there's a nee...
How would you manage a centrally located new primary squamous NSCLC after prior definitive chemoradiation to 45 Gy/30 fractions for small cell lung carcinoma?
If it is localized disease with good KPS and there is no option of surgical resection, I would consider definitive chemo/RT to 60 Gy in 30 FX. I would keep the cumulative dose to the esophagus under 100 Gy, bronchial tree under 110 Gy, and major vessels under 120 Gy.
What dose-fractionation would you recommend for post-operative radiation therapy for an excised cutaneous squamous cell carcinoma of the foot with a skin graft?
This is a tricky question. There are several factors I would like to know to recommend post operative RT: 1) What was the location of the lesion, size and histological grade? 2) Any high risk factors such as LVI? 3) I presume the tumor was resected; what is the Path status of the margins? Close, pos...
How would you approach a supraclavicular high grade monophonic synovial sarcoma?
When I see a patient who has had a partial excision of a soft tissue sarcoma, I approach further therapy as I would a new diagnosis. Our preference, in a location where wide surgical resection is often difficult, is to use preoperative RT followed by surgical resection, and that is what I would do i...
How do you manage a recurrent craniopharyngioma?
Complex answer—my personal view based on my Neurosurgery and SRS/RO experience:1. If the recurrence is a single large cyst—surgery (stereotactic aspiration combined with SRS to collapsed cyst immediately, have done the same day) or Intra-cavitary P32.2. If it's a small solid/micro-cystic recurrence—...
How do you approach a patient with ATM mutation with prostate cancer?
This is a good guide for a radiation oncologist suggesting no contraindication to RT, with a possible small increase in second cancer (most data based on breast cancer).
Would you consider APBI in a patient who received neoadjuvant chemotherapy?
I do not consider APBI in patients who have received neoadjuvant chemotherapy. While I am aware that some do, I do have concern regarding encompassing volume at risk. With more patients receiving neoadjuvant endocrine therapy, this is also an area where we don't have great data. I have not tradition...
Do you ever boost equivocal pelvic lymph nodes in a patient with low PSA who will get salvage XRT?
The question has two spins to it. Do we do it? Probably yes, as it's easy to do without much morbidity, if treating the pelvis to begin with. Does it help? We don’t know, as reactive nodes are not uncommon in the pelvis. Once PSMA scans are available, one would have a better estimation of nodal dise...
Do you use an age limit cutoff for SBRT in lung cancer?
We do not use an age-based cut-off when considering safety/eligibility for SBRT, instead treating patients with appropriate overall health and condition, and lesions which are sufficient to warrant treatment. Our own institutional experience (Videtic et al., Pract Radia Oncol 2017) describes the ou...
What fractionation would you recommend in a patient with prostate cancer and a bulbar urethral stricture?
Hopefully, the bulbar urethra would be outside PTV volume, so fractionation would not change based on that. The patient would need the stricture addressed before any treatment to help with symptomatology.