Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does Decipher score inform your practice for treating pelvic nodes in otherwise favorable intermediate risk prostate cancer?
Nodal radiation therapy in prostate cancer remains controversial. While the Decipher score correlates with lymph node involvement in pathological specimens, I have not used it to decide on pelvic nodal radiation. Two randomized studies failed to show a benefit to pelvic radiation (old studies with i...
How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?
Update: On August 6, 2024, the FDA approved Vorasidenib for IDH-mutant low-grade gliomas based on findings from the INDIGO trial. This decision highlights the FDA's incompetence and lack of scientific integrity, clearly demonstrating that the agency prioritizes pharmaceutical companies' interests ov...
Are there any contraindications to BCS and adjuvant radiotherapy in patients with BARD1 mutation?
BARD1 may be a moderate risk mutation predisposing to breast cancer, but with no contraindications to breast conservation treatment. There may be a slightly increased risk of developing a new primary in the treated breast, much like any other moderate risk gene.
Is there a limit on the number of brain metastases that can be safely treated with single-isocenter multitarget linac-based SRS using HyperArc?
When thinking about this particular question, one would have to define which metrics would be dose limiting. Most would consider a mean brain dose of about 8 Gy to be the maximum tolerated dose to the normal tissue. This could be modeled in HyperArc and is a function of the number of tumors and volu...
In the setting of an atypical lipoma/well-differentiated liposarcoma of the extremity with a small component of dedifferentiated liposarcoma, is it necessary to treat the entire mass with neoadjuvant radiotherapy OR just the dedifferentiated component that is enhancing on contrast MRI?
When treating these well-differentiated liposarcomas, I would treat the entire mass to the preop dose of 50 Gy in 25 fx. Although there may be visible areas of dedifferentiated on MRI, there may be other areas that are not visible on imaging, and thus treatment of the entire mass would be warranted....
For post-prostatectomy radiation, what rectum, sigmoid, and bladder constraints do you use?
In these cases, I follow consensus guidelines for contouring the CTV_ProsBed and also contour out the sigmoid and any small bowel. I use whole organ volumes, not just wall contours, although there are published constraints for the rectal wall and bladder wall. There are a range of appropriate constr...
What treatment fields do use for heterotopic ossification prophylaxis?
This is what I was told at HSS- Bridging ossification between the greater trochanter and pelvic bones locks the leg- this is the most important area to cover. Bridging ossifcation between the lesser trochanter and pelvic bones, I believe, presents a much more minor impairment. You dont have to block...
What volumes do you treat for unresectable tracheobronchial cancer?
There is not a lot of literature on the management of primary tracheal cancer, since it is primarily a surgical disease. In the setting where the patient is inoperable or unresectable, then by first principles since it is an aerodigestive cancer, one can extrapolate the role of radiotherapy and chem...
In patients with oligometastatic disease, would you offer SBRT to a metastatic lymph node abutting the trachea and/or esophagus?
I have treated oligometastatic lymph nodes abutting esophagus and trachea. I do not do this routinely and the risks and benefits need to be weighed in terms of whether the patient is truly oligometastatic and if there are potentially effective systemic options.For these ultracentral locations, I fav...
How do you counsel patients regarding alcohol consumption following treatment of head and neck cancer?
I always tell patients that there is no known safe amount of alcohol consumption, especially regarding the risk of developing another head and neck cancer. Most patients who consume alcohol after head and neck radiation therapy often tell me that it does not provide the same enjoyment as before due ...