Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In what situations do you consider adjuvant radiation for ovarian cancer?
Our understanding of the role of RT in ovarian cancer has been evolving. In most cases, the role is at most palliative because most ovarian cancers (particularly serous cancers) are widely disseminated at presentation. However, there is a subset of patients whose disease remains locoregionally confi...
Which PET imaging modality, if any, is preferred to work up possible nodal involvement or local recurrence in prostate cancer?
In my view, better, more sensitive imaging will transform our management of prostate cancer. Soon, I believe, maybe very soon, we'll be able to detect small volume nodal metastases and small volume metastatic disease. How to manage patients with, say, a solitary, <1 cm lymph node seen on PET will be...
When do you use a rectal spacer in combination with radiotherapy for prostate cancer?
We have done this in a few patients with high risk of complications ( history of IBD) with LDR brachytherapy. The procedure as suggested is done at the end of brachytherapy to avoid interference with ultrasound imaging. The spacer increased the distance and helped decrease the dose to rectum signifi...
For early stage breast cancer patients, should lumpectomy + RT be recommended over mastectomy?
The cancer registry based studies and long term follow-up, in my mind, reassures that even with longer follow-up, lumpectomy plus RT is equivalent to mastectomy alone without RT, and not better. That being said, a subset of early stage patients who are managed with mastectomy alone may benefit from ...
What is your approach for an inoperable patient with epidural spinal cord compression who has previously received maximum spinal cord dose during a previous course of radiation therapy?
http://www.ncbi.nlm.nih.gov/pubmed/18642349This paper highlights motor outcome in patients who had reradiation for cord compression with cumulative BED less than 120 With no RT reacted cord injury. if patient is not a candidate for surgical decompression we have retreated with EBRT and more recently...
When treating locally advanced/borderline resectable pancreatic cancer with SBRT, what are the typical duodenal dose constraints you utilize?
5-fraction pancreatic SBRT has been reported using a variety of dose constraints for duodenum, remainder of the small bowel, and stomach. The most common is a maximum dose in the ~30 Gy range. In our series from Moffitt we reported low toxicity using V1 cc < 35 Gy and V5 cc < 30 Gy although in my cu...
For patients eligible for and considering active surveillance for low-risk prostate cancer, do you routinely use tests for molecular risk stratification?
I have not incorporated genetic testing into my active surveillance strategy. As yet, it is not clear how to use this information to modify the approach to AS. At this point, multi parametric MRI is far more useful, and I recommend this test to all of my patients considering AS to try to rule out th...
How should bolus be utilized with different types of surgical reconstruction?
We currently use 5 mm bolus routinely with a TRAM, expander or implant and discontnue the bolus once grade 2 erythema develops which is usually close to halfway through the treatment. For these patients, unlike routine PMRT, we do look into dose homogeneity with the plan (using mixed beam energy) an...
Would you consider accelerated radiotherapy in a patient with locally advanced NSCLC who is not a candidate for chemotherapy?
Without knowing many of the crucial issues (tumor/target size), pulmonary function, and with the extrapolation of smaller target data, Bogart published the "fixed dose" at 70 Gy, and reduce time as others were exploring very short fraction SBRT. Others have tod me that they are using 400 cGy fractio...
What criteria do you use for recommending palliative radiation in patients who are asymptomatic but have good performance status?
There are a few circumstances for which we recommend radiation to asymptomatic patients with good performance status. Perhaps the most common situation is when a patient has a reasonably long life expectancy (at least >3 months) and the metastatic tumour has a high probability of causing morbidity o...