Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does the potential for a patient to accept or forego adjuvant tamoxifen factor into your recommendations on adjuvant RT for DCIS?
In the RTOG 9804 trial, the only factors predicting for local control in the breast were the use of radiation and of tamoxifen. So for women who have hormone positive tumors, I strongly advocate for some treatment in addition to the lumpectomy.I find the results of the UK, Australia, and New Zealand...
Is a stereotactic/ thin-slice MRI of the brain absolutely necessary to determine eligibility for hippocampal sparing whole brain radiation therapy?
The small size of the hippocampal dentate gyrus (3-4cc) can render it difficult to delineate and conformally avoid if both the brain MRI and the treatment-planning CT simulation are not obtained with thin-slice axial images (not exceeding 1.5mm on the MRI, not exceeding 2.5mm on the treatment-planni...
Should hippocampal-avoidance WBRT be the default option for WBRT?
I think this is a difficult question to answer as a lot depends on the particulars. Here's a list of some of those issues: Radiosurgery is very easily administered & frequently free of toxicity. Systemic agents are showing improved efficacy in the brain. Surveillance MR imaging = lower incidence of ...
When should you use single-fraction radiotherapy for spinal cord compression?
The SCORAD III trial is practice changing. But I do NOT plan to treat ALL patients with spinal cord compression with a single fraction of 8 Gy now. Here is why: SCORAD III is extremely important new study for the management of metastatic epidural spinal cord compression (MESCC) for patients with sho...
Do you use either memantine or hippocampal sparing technique to preserve cognitive function when giving whole brain radiotherapy?
Dr. @Dr. First Last and I put together the response below:We use memantine and hippocampal sparing technique for all brain metastasis patients who are planning to receive WBRT. This is based off the recently published phase III trial NRG CC001 that found hippocampal avoidance WBRT plus memantine res...
Would you offer hippocampal sparing whole brain radiation for patients with brain metastases due to ES-SCLC?
Until we have built-in auto-segmentation, I find the RTOG contouring atlas very helpful for manual contouring of the hippocampus. I tend to use the lateral ventricle as my main landmark, and look for the circle of gray matter located medial to it. Once I've drawn a hippocampus, I'll look at it in th...
What factors do you consider when selecting dose/fractionation for whole brain radiotherapy?
I assume this question is for brain metastases patients who are not eligible for hippocampal avoidance WBRT (ineligible criteria including but not limited to - mets 5 mm within either hippocampus, germ cell/small cell/lymphoma, leptomeningeal disease, etc.) - my default WBRT dose fractionation is 30...
Given COVID-19, is there a good hypofractionated regimen for postmastectomy radiation for locally advanced breast cancer?
In light of COVID-19, we offer 2.66 x 16 PMRT with comprehensive RNI. This regimen is under study in ALLIANCE A221505, commonly known as RT-CHARM. Primary endpoint is reconstruction complications at 2 years. We discuss with reconstructed patients (most all will take if offered). Routinely given to u...
Would you give PMRT to a young woman with a T1-2 breast cancer with a micromet on SLNB?
No great data as far as I know. In general, I treat micromets as ~pN0. @Dr. First Last and colleagues reported on LRR rates and prognostic factors for failure in pN0 patients treated with mastectomy to identify subsets of node-negative patients with sufficiently high risk of LRR who might benefit fr...
How would you manage an elderly female patient with a remote history of synchronous bilateral invasive ductal carcinoma with a new triple-negative recurrence in the left breast and axilla with extension to the contralateral breast?
Unfortunately, if no good systemic options are left including pembro/parp inhibitor then the outcome is most likely palliative. Will try a hypofractionation schedule for palliative/preoperative dose of RT.