Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does infra- versus supra- tentorial tumor location change your management strategy for the treatment of single brain metastases?
My experience has been that there is a greater risk of vasogenic edema after SRS to the posterior fossa due to the anatomical constraints. If there is marked mass effect from the lesion, I push the surgeons to resect followed by conformal XRT to the tumor bed. Otherwise, I have treated many posterio...
How do you decide on a fractionation scheme for retreatment of a progressive/painful spine metastasis?
The NCIC CTG SC20 trial tested retreatment of bone metastases and included patients with spine metastases. Both 8 Gy in 1 fraction and 20 Gy in multiple fractions for retreatment were found to be effective and safe, with a low risk of serious adverse events. The minimum time interval between initial...
In patients receiving neoadjuvant CRT for cN+ rectal cancer, do you expand your elective nodal volumes to include the external iliac chain or to extend more superiorly along the common iliac chain?
It's important to remember what is removed in a mesorectal resection. Only the mesorectal lymph nodes are removed. The external iliac and internal iliac nodes are not removed and in fact cannot even be selectively removed after preoperative therapy because they usually respond. The reason for this i...
In patients with Stage I seminoma who elect surveillance, how long do you recommend that tumor markers be followed?
I agree with @Dr. First Last that the data is vague. I would add the following: in series where patients are regularly re-staged with CT scans, serum tumor markers add essentially nothing. So if one follows the Princess Margaret Hospital schedule and gets scans every four months for the first 2 to 3...
Would you ever boost the lumpectomy cavity and the scar after whole breast RT?
The site of relapse is the index cancer location and not the scar. We boost the surgical bed with a margin and not the scar. Scar boost is a misnomer and in the modern era with screen detected cancers. the scar location is based on cosmetic outcome and not necessarily the underlying cancer location....
For recurrent prostate cancer after definitive radiation, how do you guide patients between the various salvage options vs ADT?
This is a complex clinical situation and one needs to incorporate all available evidence regarding prior XRT details and PSA trajectory and imaging workup into the treatment decision. Below is the general strategy we use at Emory: For patients with rising PSA's post XRT, one should do a DRE, bone s...
How would you treat an unresectable SCC of the skin local recurrence in the base of skull with clinical and radiographic CN involvement?
I usually target gross disease to at least 70 Gy in 35 fractions if my treatment intent is curative. I try to avoid fractional doses >2 Gy around optic nerves and chiasm, so would not typically use 55 Gy in 20 fractions for this reason. HyPERfractionaton, proton beam and concurrent systemic therapy ...
Would you recommend lung cancer screening in someone who is not a surgical candidate?
This is our commentary on this topic: http://www.ncbi.nlm.nih.gov/pubmed/26226384
In a patient with ER+/HER2- breast cancer, do you ever use Oncotype testing to assist in decision-making regarding adjuvant chemotherapy when the tumor size is less than 0.5 cm, or when there are positive lymph nodes?
The NSABP and other data that was approved for prognostication and for prediction of benefit with chemo excluded 5 mm or smaller tumors. In practice, oncologists would not offer chemo for ER positive and node negative tumors that are 5 mm or less in size . Thus, I would not do oncotype do testing. B...
In women with cN0 breast cancer who receive neoadjuvant chemotherapy due to other high-risk features, how does the finding of treatment effect in a post-chemo sentinel lymph node affect your radiation recommendations?
The answer is not known and I am sure practice pattern varies. Our decision to treat regional nodes is usually based on the number of sentinel nodes dissected (the negative predictive value of residual disease in the axilla is a function of the number of nodes and the use of dual tracer in clinicall...