Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach treatment for isolated vaginal cuff recurrence of endometrial cancer in a patient previously treated with adjuvant vaginal cuff brachytherapy?
We take previous brachy dose into account. If the patients have a CT based plan from their previous brachy, then we calculate the 2 cc dose to rectum and bladder from previous RT. Based on that dose, we deliver 30-36 Gy to pelvis including entire vagina, paravagina and nodes with EBRT, and after tha...
When giving palliative lung radiation to a patient on immune checkpoint blockade for NSCLC, do you hold immunotherapy?
Most of the palliative lung RT regimens include either 3000 cGy in 10 fractions using 300 cGy per fraction or 3500 cGy in 14 fractions using 250 cGy per fraction. As the experience is limited on the concurrent use of palliative RT with immunotherapy, I withheld immunothearpy while treating the lung ...
Can any non-SBRT hypo fractionation regimen for prostate cancer be regarded as the new standard of care, or as an equal alternative standard of care?
RTOG 04-15 (N = 1092) – W Robert Lee et al. Disease state: Low risk PC Randomization: 73.8 Gy RT in 1.8 Gy fx’s versus 70 Gy RT in 2.5 Gy fx’s (Non-inferiority design) Median Follow up: 5.8 years Toxicity: Significant increases in both Gr 2 + and Gr 3 + late GI and late GU toxicity with hypofraction...
Which, if any, aspects of your management of prostate cancer differ in your African-American patients versus those of other racial/ethnic backgrounds?
My short answer is that I do not treat patients diagnosed with prostate cancer differently based on race or ethnicity. There is data to support a higher risk of progression on active surveillance among African American men as compared with Caucasian American men with low risk prostate cancer, but th...
Should 4 Gy x 5 be the standard of care for spinal cord compression in patients with poor prognosis?
Wow, so this question was asked in 2016 and nobody has taken a whack at it. 30 Gy in 10 fx has been the long-standing standard dose for SCC in most countries for just about ever. This has not been compared to other doses until more recently. 30/10 works well, is relatively short (2 weeks), and utili...
How do you manage an open wound that is not healing after radiation treatment for an ulcerated SCC of the scalp?
There always has to be high suspicion for persistent disease, so consider a punch biopsy. Sometimes repeat biopsies are needed to confirm recurrence. Sometimes localized surgery without general anesthesia can be performed to freshen the wound and promote graft placement. Tertiary centers may have ex...
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...