Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
For lung SBRT, do you constrain dose to small bronchioles/small airways?
Hi MedNet,I got this question via email as well and answered it there, but for the broader community, I’ll answer here too.I do not. There are many ways to think about problems like these and a lot depends on the patient’s characteristics. There’s a convincing amount of anecdotal data that ultra cen...
Are there any breast ca patients for whom you would offer PMRT if they were cN0 and ypN0?
There are a few patients, I will still offer RT for if they are cN0 and ypN0. cT4 disease T3N0- will consider for young age, triple negative I don't routinely offer to cT1-2N0 patients unless positive margins.
How do you classify extensive LVSI in endometrial cancer?
There are various definitions floating around but one with an outcome in the absence of nodal dissection is from PORTEC group showing the significance of 4 or more vessels involved.Peters et al., PMDI 34261899 Our data questions the true significance of substantial LVSI > 1 vessel as used in previou...
Is it appropriate to use bolus with hypofractionated PMRT?
Bolus is being used less and less. Most people would only use if T4 disease or if they had a positive margin or some other high-risk factor for skin/superficial recurrence. The indication for bolus would not change based on fractionation. If there was an indication to bolus with conventional, then y...
Would you consider APBI in a patient who meets all criteria but has high-risk genomic testing and is not receiving chemotherapy?
I would proceed with APBI 30 in 5 as it has a boost dose built in to account for a high genomic score.
Should other treatment options be considered for MALT lymphoma if the lacrimal gland will be included in the radiation field in a patient with Sjögren's disease?
The orbit is the second most common site of origin for extranodal marginal zone lymphoma (MZL). Involved orbital structures include the bulbar and/or palpebral conjunctiva, lacrimal gland, and periorbital soft tissues. Patients with Sjögren’s syndrome (SS) are at increased risk for developing extran...
Does the choice of radiation modality (3D, IMRT/VMAT, protons) impact the effectiveness of the reduced dose of 20 Gy in DLBCL?
I don’t think modality (IMRT vs 3D vs protons) has an impact on the effectiveness of the reduced dose of RT.
For biopsy proven extranodal marginal zone lymphoma involving two small bilateral lung nodules, would you consider definitive treatment to both nodules with radiation therapy?
It has been observed that many patients treated with radiation therapy for an extranodal MZL in a paired organ (orbital and parotid, in particular) will develop metachronous disease recurrence in the contralateral organ (Goda et al., PMID 20564130). In fact, it is relatively common for patients with...
For stage III-IV Hodgkin's lymphoma, would you consider consolidative radiation for bulky disease after a complete response was seen using N-AVD per the S1826 trial?
I would offer consolidative radiation only for PET-positive residual disease.