Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For an unknown primary manifested in a left supraclavicular node, what area would you treat with radiation therapy?
Is it adenocarcinoma or squamous cell carcinoma as suspected primary could be in head and neck region or abdominothoracic region in practice I have treated once for squammous cell cancer and opted to treat ipsilateral involved site only with adjoining level 4 and 5 region.
Does finding a positive surgical margin containing pleomorphic LCIS in a patient with early-stage invasive ductal carcinoma of the breast affect your management in regards to breast conservation therapy?
Based on limited data, we treat PLCIS with the same principal as DCIS and aim for a negative margin and offer adjuvant RT. PLCIS presents with microcalcs like DCIS and in the pre e-cadherin staining era, they were called DCIS and included in the old NSABP study as DCIS.
What dose is required to gross disease in the definitive treatment of vulvar cancer?
As with all gynecologic carcinomas, the optimal dose is at least to some extent dependent on the volume of disease. However, our experience suggests that a minimum of 60 Gy should always be given for gross diasease, even when concurrent chemotherapy is being given. That said, for gross disease that ...
Is hypofractionation ever appropriate in women with early stage breast cancer and latent lupus who have never experienced skin symptoms in their lifetime?
Short answer: Yes. I do offer HFRT to such patients. No. I would not advise a "wait-and-see" approach. Long answer: There are actually two categories of considerations here: First, are you comfortable treating patients with autoimmune/collagen vascular disease (CVD)? If so, are you a "lumper" or a ...
What technique, total dose, and fractionation do you use for DCIS following lumpectomy with <2 mm negative margins which are not re-excised?
We use 50Gy/25fx and 10Gy/5fx boost for DCIS pts with close margins. Post -lumpectomy mammograms should be obtained to rule out residual calcifications.
What are the advantages and disadvantages of concomitant versus sequential boost for treating cancers of the head and neck with IMRT?
When using SIB for HN IMRT there are a few different options for dose levels. In the definitive setting, I typically use 70/63/56 Gy in 2.0/1.8/1.6 Gy/fraction over 35 fractions. The 1.6 Gy/fraction is less than ideal, but the small dose escalation to 56 Gy (rather than 50 Gy in 2 Gy/fraction) makes...
How do you advise patients on the risk for permanent alopecia following RT to the scalp?
If you are treating the skin in a certain area to definitive dose with RT for a skin primary, the patient is almost certain to have a patch of alopecia in the area of treatment. Regarding dose constraints, one older study by Lawenda and colleagues looked at 26 patients treated for CNS primaries and ...
What dose do you recommend for salvage radiotherapy after biochemical recurrence in prostate cancer?
We normally give dose of 66.6 Gy which should be sufficient for microscopic disease. In patients where there is imaging suggesting recurrence or the pre-RT PSA is high then we consider going to 70 Gy for a high volume of disease while taking normal tissue dose into account.There is data for dose esc...
How do you deal with wounds in or around the radiation fields?
Agree with @Dr. First Last completely. As another example, a slowly healing drain or mastectomy wound that remains open during chemotherapy will often close during radiation, despite being within field. I monitor and continue standard wound care, but do not change my treatment fields.
If a patient with a seminoma fails after chemotherapy in the paraaortic nodes, what is the best salvage therapy - different chemotherapy or radiation?
It depends on what the prior intent of chemotherapy was, what type it was, how confident you are that the patient has indeed relapsed as well as the size of the nodes. Three scenarios might be considered. If the patient received adjuvant carboplatin, somewhere between 5 and 10% will relapse and 75% ...