Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a low volume prostate cancer (2 of 12 cores, low percentage) with a GS 4+4=8, how long does ADT need to be administered?
The role of ADT for high-risk disease continues to evolve, with new data emerging annually. While guidelines typically recommend 2-3 years for any high-risk patient, not all have the same risk of failure and/or benefit from ADT. Initial phase III studies from the RTOG & EORTC that showed OS benefits...
Should nodal fields be added to post-mastectomy radiation treatment after neo-adjuvant chemotherapy if there is a CR in the nodes?
There is no good study for this clinical situation. NSABP is conducting a trial where pts who have pCR in clinically positive nodes are being randomised to regional RT vs. no regional RT. In practice, I usually treat for patients with pretreatment clinical N2 disease or have inflammatory breast canc...
Can you observe low grade follicular lymphoma if the involved node(s) have been surgically removed?
There are certainly circumstances where observation for limited stage, low grade follicular lymphoma is warranted. I would not rely on surgical resection alone for cure however. Occasionally surgery can be curative in Stage I extranodal MALT lymphoma.
What is the best treatment dose and fractionation for WBRT in a patient who has numerous brain mets and previously received PCI with 25Gy/10fx for small cell lung cancer?
Based on re-irradiation series for whole brain available in literature (Value of whole brain re-irradiation for brain metastases--single centre experience. , Re-irradiation in the treatment of patients with cerebral metastases of solid tumors: retrospective analysis. ), reasonable palliation (improv...
How often do you order follow up mammograms after breast radiotherapy?
We do it once a year, as doing them more frequently than that has not been shown to improve outcomes and this is endorsed by national societies. There is a recent paper which showed higher yields with 6 month mammograms but this has not shown to improve outcomes and our approach at present is a year...
Is it acceptable to treat glioblastoma with upfront SRS instead of fractionated external beam RT?
There is good prospective randomised data in this setting for using hypofractionated RT alone (34/10 fractions or 40/15 fractions) or Temodar alone (if MGMT methylated). If the goal is palliation and QOL improvement, either of the two based on the clinical situation is a viable option.There is no go...
Do you treat neck nodes electively in transglottic/bulky T2N0 laryngeal cancers?
Generally no, but if (in particular the supraglottic) extension is significant beyond the glottis, I might give it consideration. In general nodal recurrence rates for t2 glottic is low (~5%); granted not all t2 glottic tumors have extension beyond the glottis, so the incidence may be higher for tho...
Should I decline to treat a patient with a first site of metastasis who refuses a biopsy?
Ideally, all patients with a first site of metastatic disease should have a biopsy. However, the details are critical. Is the location amenable to a bx? Is the patient's performance status poor? Has it been an extended period of time since treatment for the primary disease? Is it a solitary metastas...
In SBRT for lung tumors, does Monte Carlo dose calculation algorithm versus AAA dose calculation give a better representation of lung target dose and normal tissue dose?
I am not a physicist, and they are much better suited to answering this question than I am, but I like physics and I'm willing to take a stab at it. Monte Carlo is the gold standard for dose calculation. There is nothing better aside from other Monte Carlo alogrithms. When I first heard the terms I ...
Is social media useful for radiation oncologists?
Social media are digital communications tools which can magnify the good or harm we can do as doctors. Currently, there are many important conversations taking place online about cancer care. If we want our field to be valued and to make a contribution to the future direction of oncology, we have to...