Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for radiation in the treatment of superficial, non-muscle-invasive bladder cancer?
The data from Germany looks good for high grade non muscle invasive disease with chemo RT. Based on this, RTOG also has a protocol for this subset. There is no randomised comparison to surgery, but compared to the published surgical data, it looks comparable: http://jco.ascopubs.org/content/24/15/23...
Can the elective target volume in nasopharyngeal cancer, as specified in RTOG 0615, be reduced if OARs do not meet constraints?
Always protect the brainstem, spinal cord, and chiasm and by that, there will be some compromise of the target. One should not change the target.
How do you effectively spare the medial RP nodes and superior constrictors when you contour the bilateral RP nodes and place a 3-5 mm CTV to PTV expansion?
If you use PTV margins of 3 mm (allowed if you check set-up imaging before each treatment and adjust for set-up deviations), and you mark the lateral RPN CTV in the triangular space between the carotid artery and the longus muscle, You will be able to spare the part of the constrictor which is betwe...
What factors would lead you to consider RT for men with Stage I seminoma?
I strongly agree that observation should be the first option for Stage I seminoma with normal postop markers. Since cure rate is near 100%, we should be looking for the least morbid managment strategy. I generally favor observation with an expectation that para-aortic relapses of less than 5 cm shou...
When deciding whether to include an IMN field in a PMRT case, what do you consider a "safe dose" to the heart that you are willing to accept?
I agree with @Dr. First Last about keeping the heart dose as low as possible. Aim for a mean heart dose of ≤ 4 Gy. I prioritize the heart dose constraint, especially in younger women, women with pre-exisiting cardiac conditions and those who have had cardiotoxic chemotherapy. This may sometimes requ...
When do you start temozolomide with RT for high grade glioma?
Thanks! Will be interesting to see the differing views. I was "brought up" in residency to believe that TMZ is a radiosensitizer, but have been thinking about it more closely; why an alkylator would synergize with RT seems increasingly unclear to me.Many people say it acts as radiosensitizer from cl...
How do you take tumor seeding into account when staging NSCLC?
This is a rare situation but based on the current AJCC staging, if this is in same lobe then would stage as T3 disease. If discovered after treatment of the primary disease, we would still treat this like a localized process, as is not hematogenous spread and not like metastatic disease. Seeding of ...
Would you offer PMRT for an axillary-only recurrence after a remote mastectomy and ALND in a patient with early stage breast cancer?
Yes. This patient's relatively early recurrence in the axilla is an indicator of either suboptimal initial surgery, aggressive biology, or both. Following axillary dissection, chemotherapy may be warranted and a discussion with the medical oncologist is certainly appropriate. Following chemotherapy,...
Do you treat the contralateral RP nodes up to the base of skull in a node-negative neck if the primary tumor involves any hypopharyngeal subsite?
An older Red Journal article (Chao et al., 2002) provides some recommendations on RP coverage on the basis of recurrence data/ nodal involvement at presentation as stratified by subsite. The tables in this paper have many strata, however briefly according to the data compiled in this paper of the pa...
What specific dietary changes do you recommend for patients undergoing H&N, CNS, or GI RT?
I would leave Boost and Ensure as the absolute last recommendation possible. This goes for Carnation Instant breakfast as well, which is mostly made up of sugar and high fructose corn syrup. These supplements are poor sources of nutrition for anyone, let alone cancer patients. As cachexia is a state...