Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you treat elective cervical lymph nodes for SNUC (sinonasal undifferentiated carcinoma) of the ethmoid sinus?
I would always cover bilateral levels II-IV, and also ipsilateral IB if there is nasal cavity involvement. If clinically node negative, high level IIB can be omitted.
Is there an advantage in treating with a SIB (simultaneous integrated boost) over sequential boost for anal cancer?
Radiation therapy, in almost everything we do, is a trade-off betweeen tumor control and toxicity. This gives us the opportunity to change dose and fractionation to obtain what we perceive as the "correct" balance between aggressiveness for tumor control and being conservative to preserve function a...
How would you design PORT volumes for a patient with NSCLC and positive chest wall margin?
A positive surgical margin (bronchial, vascular, parenchymal) after a typical lobectomy/pneumonectomy for NSCLC is rare (~1-2%- JTO 2015;10:1625), a bit higher after sublobar resection, and even higher after chest wall resection (14% in our series- Tandberg et al. Clin Lung Cancer 2016). The most ac...
Do you offer TTF for patients with newly diagnosed GBM?
I would describe it as unethical to not discuss TTF as an adjuvant therapy in the majority of patients with a GBM. The size effect in the randomized trial was twice that of temozolamide and we all agree on strongly recommending in general. The benefit was an overall survival benefit and the practi...
For postoperative gastric patients status post total gastrectomy, how do you approach anastamotic coverage?
In the Gunderson re-op studies, local regional recurrences occurred in 38% of patients when assessed clinically, 67% when assessed by re-operation and 80-90% at autopsy. Of the local recurrences, 25% occurred at the anastomosis or duodenal stump when assessed clinically or by reoperation, and 50-60%...
Who discusses and prescribes TTFs at your facility?
Strong multi-disciplinary support is key to developing a robust TTF program. Our neuro-oncologist and surgeons are fortunately on board with discussing this as a standard option for GBM patients. TTF is prescribed by the radiation oncologists at our institution.
Is it appropriate to use moderate hypofractionation for the treatment of patients with high-risk prostate cancer?
At Fox Chase, we conducted a phase III randomized prospective clinical trial comparing conventionally fractionated IMRT with moderately hypofractionated IMRT from 2002-2008, for men with intermediate and high risk prostate cancer. Men were randomized to 76 Gy in 38 fractions or 70.2 Gy in 26 fractio...
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?
Another consolidative option is non-myeloablative chemotherapy with etoposide plus cytarabine (EA) based on the CALGB 50202 trial (Rubenstein et al., JCO 2013) using MTR induction, followed by consolidation EA. In that trial, the 2-year time to progression was 59%, and for patients who completed con...
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...