Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your advice to patients who ask if dental X-rays correlate with oral/oropharyngeal cancer?
No good data to support positive correlation between dental X-ray and oral/oropharyngeal cancer Bharat
Do you use breath hold techniques to minimize heart dose in whole breast radiation?
We do 2 CT scans (free breathing and deep breath hold) for every patient with left sided breast cancer treated in the supine position. We then create volumes and blocks for both scans and select the DIBH plan if it offers a clear advantage. Our approach is to attempt to keep mean heart dose under 1 ...
Is it acceptable to use SBRT for prostate bed RT?
In my opinion, this should not be done outside of an IRB-approved research study. We are beginning to see some published experience with moderate hypofractionation in post-prostatectomy patients, which would indicate, at least preliminarily, that this approach may be safe, although the optimal dose ...
Would you hypofractionate breast cancer patients with >25 cm separation?
According to the most recent ASTRO whole breast fractionation guideline, the decision to offer HF-WBI should be independent of breast size (including central axis separation) provided that dose-homogeneity goals can be achieved. The guidelines recommend that the volume of breast tissue receiving gre...
Do you treat with high-dose radiation alone (without ADT) for favorable intermediate risk prostate cancer?
We do treat so-called low-intermediate risk prostate cancer with RT alone (brachy alone or high dose IMRT). The critetia we use is GS 3+4, low number of cores being positive, non-palpable disease, and PSA close to 10.The impact of short term androgen ablation with high dose RT is not clearly defined...
What field and dose would you prescribe for a an extra-renal rhabdoid tumor of the pelvis?
Extrarenal, noncerebral rhabdoid tumors are relatively rare. However, the literature indicates an advantage for delivery of radiation therapy. Bourdeaut et al in 2008 reported on 26 patients with extrarenal, noncerebral rhabdoid tumors in whom the only surviving patient who had a proximal limb tumor...
Do you recommend hypofractionated/Canadian fractionation for in-situ ductal cancer?
The same pretzel logic used to deny hypo fractionation to patients with DCIS was used in the 80's to deny them breast conservation. It is not only reasonable to extrapolate the data from over 7000 patients with early stage invasive breast cancer on the British and Canadian trials, it is necessary fo...
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 ...