Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
What is your preferred treatment choice for GBM that crosses the corpus callosum?
We never push for aggressive surgery in this case. The surgeons will not resect disease from the corpus callosum (due to resulting neurological issues), so further attempt of surgery would delay therapy in a group of patients that tend to do poorly, despite favorable prognostic factors.
Do you make any distinction or have any special consideration when considering a patient for hypofractionation for left versus right breast cancer?
In general I see no major issue with hypofractionation and cardiac issues. Whether standard or hypofractionation the cardiac dose should be minimized to the greatest extent possible by any combination of techniques including deep breath holding, cardiac blocks, etc. Keeping the mean heart dose as lo...
Is it possible to palliate presacral recurrences of rectal cancer in patients who previously received neoadjuvant chemoradiation to the rectum?
Our institution has reported on a small series of presacral recurrences in previously treated patients with SBRT with good response and palliation.http://www.ncbi.nlm.nih.gov/pubmed/22269400