Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In post-op RT for head and neck cancer with a close or positive margin, is there data suggesting that 66 Gy at 2 Gy per fraction provides better local control than 63 Gy at 1.8 Gy per fraction?
I do not think there is any good data to support this. Historically, 2 randomized trials come to mind. The first is the MDA Peters et al trial, that looked at varying doses with 1.8 gy fractions, and concluded that 63Gy was the optimal dose for higher risk patients. The second study was published by...
Would you treat the inguinal nodes in a patient who had an adenocarcinoma excised from the anal canal?
I would definitely include the external iliac nodes for such a case. I would also definitely add the inguinal nodes if the cancer were extending to the verge or beyond. I would also scrutinize the imaging studies very carefully; a 1-2 cm inguinal node has to be of greater concern in this setting tha...
Are there situations where you would use hypofractionated radiotherapy for Stage III breast cancer?
The answer to this question is complex, and cannot be adequately explained in a brief response.Treatment of local advanced breast with hypofractionated radiation is not currently an accepted standard practice in this country. This situation occurs in both breast conservation and mastectomy (+/- reco...
When treating rectal cancer with neoadjuvant chemoRT, is it appropriate to employ IMRT planning, rather than 3D conformal, for all cases, or should IMRT be reserved for special circumstances?
Special circumstances. When considering the use of IMRT for any disease site, one should always have evidence to support it over 3D CRT or at least a good rationale if there is a gap in the evidence. For rectal cancer, there is not much evidence that IMRT reduces acute GI toxicity. The RTOG 0247 was...
Do you treat rectosigmoid/upper rectal cancers with neoadjuvant chemoradiation?
The 12-year update to the phase III pre-op RT Dutch rectal trial found a local control benefit with RT regardless of location (VanGijn et al., Lancet Oncol. 2011; 12(6):575-82.). In the Dutch update, tumor location was analyzed as a continuous variable. This is different from the every 5 cm cut-offs...
What dose and expansion of GTV is recommended for a low grade glioma?
I think doses between 45-54 Gy are probably reasonable for low grade gliomas when electing to treat with RT. Several studies have not shown a benefit with dose escalation in the treatment of low grade gliomas (EORTC 45 Gy vs 59.4 Gy; Intergroup 50.4 Gy vs 64.8 Gy). In terms of treatment volumes, RTO...
What is the ideal time interval to wait before starting radiation for postoperative treatment of benign brain lesions?
The answer to this question may vary by tumor type and expected tumor growth rate, but since meningioma was first among the cited examples, permit a brief comment with that in mind. For meningioma, likely quite similar to acoustic neuroma, pituitary ademona and other typically slowly progressive CNS...
How do you approach lung tumors with vessel encasement, especially in someone with active hemoptysis?
It's a good question and not one that has a ton of published data to support. If you look at the GYN literature for palliation of vaginal bleeding, hypofractioned RT can be a very useful treatment, suggesting a role in other sites. My impression is always that those are very vascular malignanies and...
Is there a role for consolidation radiation in a patient with stage I low grade follicular lymphoma treated with chemotherapy?
First, while there is no "standard" treatment for stage I follicular lymphoma due to a scarcity of randomized studies, most North American and European guidelines indicate that the "preferred" treatment is radiation therapy. This is based on several single institution series demonstrating that radia...
Does the molecular subtype of breast cancer influence your decision to give hypofractionated radiotherapy?
I heard Jay Harris speak at ACRO last year and the Dana Farber/Brigham has a personalized BCT approach based on molecular subtype ‘Personalized’ BCT based on Subtype, Age (DFCI/BWH) Luminals Age > 60: 266 x 16, no boost Luminals Age 50-60: 266 x 15, 250 x 2 HER2+ Age > 50: 266 x 15, 250 x 4 < 50:...