Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In patients with concomitantly diagnosed stage IV DLBCL and gastric MALT lymphoma who have residual gastric MALT after 6 cycles of Pola-R-CHP, would you alter the standard dose/fractionation for ISRT for the gastric MALT lymphoma?
Chemoimmunotherapy, while potentially curable for aggressive non-Hodgkin lymphomas such as DLBCL, is not generally considered a curative treatment for low-grade histologies, such as follicular and marginal zone lymphoma. After completing appropriate therapy for the more aggressive histology (DLBCL),...
What radiation fields would you recommend in a young patient with luminal B histology and ITCs in a single sentinel node?
I would not change the RT field, which could be APBI or whole breast, based on technical and biological factors (presuming this is upfront ITC).
How do you manage chronic radiation laryngeal edema for patients treated with RT for a larynx primary in the past?
I agree with @Dr. First Last's response above. I think it is important to differentiate between laryngeal edema resulting from RT and persisting as a sub-acute toxicity, as opposed to a patient who was treated in the past for larynx cancer and then develops laryngeal edema unexpectedly. In the forme...
When, if at all, would you consider sequential chemotherapy and radiation for locally advanced lung cancer instead of concurrent?
Surprisingly contentious. Concurrent provides slight advantage in those that can take it without interruptions. Sequential is better for marginal performance status, poor support systems, homeless. If locally symptomatic, XRT first, otherwise 2-3 cycles chemo.
How important is the timing of weekly cisplatin in concurrent chemoradiation for definitive treatment of cervical cancer?
Weekly cisplatin in concurrent chemoradiation for cervical cancer serves as a radiosensitizer. Theoretically, it makes most sense for the chemotherapy to overlap as much as possible with the radiation. This is why typically these regimens are started on a Monday, and ideally the dose of cisplatin sh...
What V5 dose constraint best correlates with late lung toxicity following definitive chemo-radiation for lung cancer?
In any radiation plan, improving conformity depends upon spreading the “low dose bath†or the V5. For years, there has been a lot of theoretical concern about spreading the low dose base and a number of retrospective analyses suggesting that the low dose bath might have some impact for the defin...
What is a safe dose to deliver to a gastric bed recurrence adjacent to the duodenal stump post total gastrectomy for gastric carcinoma?
We have published that gastric bleeding occurs commonly with volumes greater than 40cc receiving 50Gy or more, in patients receiving ablative radiation in 15% for large left lobe intrahepatic cholangiocarcinomas. Having a primary liver tumor is probably associated with unrecognized coagulopathy in s...
Can the tracheostomy be reversed after completion of chemoradiation for laryngeal cancers?
Yes, if there has been a CR. Wait 3 months. PET. If negative, plug trach for 2 weeks. If all is well, pull trach.
Would you ever discourage salvage prostate XRT given a patient's lower urinary tract symptoms?
If the patient has post-op obstructive symptoms, it's possible the patient may have a bladder neck contracture. They might benefit from a urologic evaluation with cystoscopy which might address the issue. I would try to have that done prior to salvage RT. It is conceivably possible that there also c...
How exactly would you utilize ADT via leuprolide or bicalutamide with salvage RT post prostatectomy with PSA >0.5?
The dilemma on the need for hormonal therapy in the salvage radiation setting after radical prostatectomy is a major one in current clinical practice, driven by the modest survival benefits seen in the RTOG 9601 trial with 2 years of bicalutamide (Shipley et al., PMID 28146658), but also follow up s...