Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you decide on the modality of consolidative treatment after a CR in primary CNS lymphoma patients treated with a high-dose methotrexate regimen?
Unless there are contraindications to autologous transplant I favor consolidation with autologous transplant. The long term complications of whole brain XRT include significant neurocognitive deficits. These approaches are rough equal with regards to efficacy.
At your institution how are cervical cancer patients managed who are intraoperatively found by frozen section to have positive pelvic lymph nodes?
At our institution if found intraoperatively then we abondon radical hysterectomy and treat with definitive chemo RT. Idea is to avoid increased complications with combination of surgery,RT and chemo vs. only chemo RT
Do you have a tolerance dose for a skin graft when treating a high-risk skin cancer?
Surprisingly, skin grafts are extremely tolerant of radiation therapy. This is probably due to the low oxygenation saturation. I generally treat across the skin graft, considering it nothing more than normal tissue when I am attempting to either prophylactically or specifically treat cancer in and a...
For clinically node negative large squamous cell carcinomas of the scalp vertex, would you electively treat the nodes?
In most situations, no. I might consider it for a patient coming in for adjuvant radiotherapy to the primary site, if I do not anticipate that the patient would be able to undergo a salvage therapeutic lymphadenectomy over the next 3-4 years because of medical comorbidity. The rationale is that ele...
How do you manage patients who need radiation for synchronous locally advanced head and neck cancer and locally advanced breast cancer?
Have never done it but dont see any reason why RT if needed can't be addressed to both sites at the same time
Do you ever use molecular assays such as Oncotype to modify your recommendations for withholding RT after lumpectomy in invasive breast cancer?
This is part of the ongoing IDEA study. At present, we don't use Oncotype DX information for withholding RT for invasive breast cancer after lumpectomy.
How would you manage a patient with a rapidly growing, clinically localized breast cancer who is medically inoperable?
I would consider chemoRT for a medically inoperable breast cancer. Here is a prospective trial (https://www.ncbi.nlm.nih.gov/pubmed/20878462) that used paclitaxel and radiation to treat locally advanced breast cancer in the pre-op setting. I use this in the palliative setting for medically inoperabl...
Do you consider idiopathic pulmonary fibrosis a contraindication to lung SBRT?
The number of IPF patients treated at our institution has been relatively small, at less than 5%. When they have presented with medically inoperable early lung cancer, we have discussed the risk and benefits of lung SBRT with a focus on lung toxicity that may be more prevalent in this clinical scena...
Should adjuvant radiation be given for an atypical (WHO II) meningioma of the thoracic spine after gross total resection?
Overall data are thin in this arena, in large part due to the relative scarcity of the disease. We recently published a bi-institutional experience (Wash U/U of Utah) of the largest cases series to date of 102 patients with spinal atypical meningioma (AM) underoing resection (Simpson I-IV) (Sun et a...
Would it be appropriate to treat an adult with a pure germinoma at 1.8 Gy/ fraction instead of the pediatric dose of 1.5 Gy/ fx when treating with radiation alone to the whole ventricle (with cone down to primary)?
We have utilized 1.8Gy per fraction as part of an institutional protocol for CNS germinomas since the 1990s with excellent results (Buckner J JCO 1999). Although the protocol was designed to examine the safety of focal radiotherapy in the setting of CR to induction chemotherapy, this protocol also i...