Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it safe to offer breast/chest wall radiotherapy while a patient is receiving Perjeta?
The question of concurrent pertuzumab and radiation in the palliative setting will likely come up more often now with the recent striking improvement in overall survival of 15.7 months in stage IV HER2+ patients treated with docetaxel pertuzumab and trastuzumab as compared with docetaxel and hercept...
In what situations do you recommend adjuvant radiotherapy for colon cancer?
It is appropriate to be cautious when considering the use of CXRT in patients with resected colon cancer. The main reason is that in the post-operative setting there is almost always fixed small bowel adherent to the tumor bed. For this reason, one may not be able to deliver a high enough dose to pr...
When treating bladder cancer with CRT in the bladder preservation paradigm, do you cone down to partial bladder or the whole bladder?
I agree with @Dr. First Last about whole vs. partial bladder "cone-down", although in my experience I'm much less like than @Dr. First Last to treat partial bladder. In addition to the trials mentioned, the old SWOG experience (Combined 5-fluorouracil and irradiation for transitional cell carcinoma ...
Should early referral to palliative care be standard of care for all patients with metastatic cancer?
There are data to support that early palliative care involvement can improve patient quality of life. One study that specifically comes to mind is a study published by Temel et al in NEJM 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20818875) in the setting of metastatic NSCLC. This study randomized pat...
What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?
Recommend 3000 cGy in 15 fractions
In evaluating V20 for lung RT, how should the lung volume be defined?
Most of the published data is on both lungs minus PTV. QUANTEC accounts for all normal lung treated minus GTV, and this is what we favor now. There is a small difference in numbers between the two approaches. Attached is a link to a dosimetric study we did in this regard to this to quantify this dif...
Is there a role for anti PD-1/checkpoint inhibitors or other immunotherapies with radiation?
There's a lot of enthusiasm, and fairly little evidence so far. Driving the interest is the observation made over the past several decades, that radiation can induce an immunologic/abscopal response: that by treating one site of disease, a systemic response is initiated that results in responses in ...
For T4a bladder cancer only involving the prostatic stroma and no bladder involvement, what is your final cone-down volume?
For bladder tumors that are well localized, whether the tumor is well localized in one portion of the bladder or well localized by virtue of primarily prostatic involvement, it is appropriate to provide a tumor-focused cone-down volume assuming one can provide image guidance or otherwise ensure that...
What are your criteria for treating a patient with lung SBRT in the absence of a biopsy?
First I would say that there is no standard answer to this, and the crtieria are going to depend on your population and the experience of you and your colleagues.. The group at VU has published their experience treating "clincially diagnosed" early lung cancer with SBRT, and found that the outcomes ...
What is the evidence that we should do anything different in breast cancer patients with 1 to 3 nodes involved versus those with four or more nodes involved?
A careful read of the literature will demonstrate that there is nothing magical about the threshold as one moves from 3 to 4 involved nodes, that the risk of a local regional failure increases almost linearly with the number of positive nodes, and that the addition of postmastectomy radiation improv...