Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What stomach constraint would you accept in abdominal reirradiation?
For patients with at least one year interval, we reduce the standard GI luminal constraints by 10%. We use a point dose constraint as well as a 40 cc constraint. We almost always use 1.5, 1.8, or 2 Gy per fraction. For example, for 45 Gy in 25 fractions or 39 Gy in 26fx fractions BID, we would allow...
Can palliative radiation be used to treat recurrent malignant pleural effusion in NSCLC?
There has been gradual recognition of improved survival with the administration of three-dimensional radiotherapy (3D-CRT) to the primary tumor in the context of systemic chemotherapy, EGFR-TKIs, or immunotherapy in patients with stage IV non-small cell lung cancer. (Zheng et al., PMID 31040256, Arr...
Would a longstanding diagnosis of multiple sclerosis impact your radiation recommendations for a patient with breast cancer?
In my opinion, the simple answer is no. At least not in my experience treating one MS patient with whole breast radiation. Unlike Scleroderma, which is an autoimmune disease that can result in inflammation and thickening of the skin, connective tissues, and internal organs, MS is an autoimmune disea...
For biochemical failure following prostatectomy, is there a PSA value that would be considered too high to offer local salvage radiotherapy?
While I don't advocate an absolute PSA cut-off for offering salvage RT, the evidence would suggest that the higher the PSA, the lower the chance of success, especially for higher grade tumors. Patients with PSAs above 2 or so appear to have a poor prognosis with RT alone, but I would not consider th...
In a patient with pancreatic cancer who is heterozygous for the ATM c.875C>T (Pro292Leu) mutation with functional impairment in the gene product, is there any data or recommendation to support using SBRT vs. chemo-RT?
Ablative-dose radiation (100 Gy BED) is a curative option, with LC and OS similar to surgery. Everything else is palliative. 50 Gy in 5 fx with MRgRT is an evolving standard. The patient should be informed that this option is available at many centers. Otherwise, any palliative dose is fine. With th...
Would you consider RNI in a patient with axillary recurrence after lumpectomy, whole breast RT and cavity boost 10 years ago?
This patient has residual nodal disease after neoadjuvant chemotherapy and has a high risk of recurrence. I have typically treated the supraclavicular fossa and at risk axilla using a VMAT technique to limit skin dose in the area of overlap. You have 10 years of repair and the patient should tolerat...
When should surgical tumor resection be considered in patients with a low-grade glioma?
In adults with low-grade gliomas, there is substantial evidence suggesting that aggressive, early surgical resection improves outcomes and survival (Jakola et al., PMID 23099483). Historically, this has been particularly true for tumors that carry an IDH mutation or 1p/19q codeletion. This survival ...
Do you obtain MRI for cutaneous SCC with microscopic PNI to assess for gross perineural tumor spread?
I would recommend both an MRI as well as consulting the pathologist regarding the exact nature of the PNI. We had an experience with more than 100 patients (Sapir et al., PMID 27475277). Those with gross PNI (evidenced by MRI, with or without cranial nerve deficit) and microscopic extensive PNI (>2 ...
What do you use for IGRT for definitive H&N IMRT treatments?
I use daily CBCTs for H&N setup. This is used mainly to line up bony landmarks prior to daily radiation delivery. However, this also allows me to track changes in body contours due to weight loss or reduction in nodal GTV. I use this information for adaptive RT planning when needed such as when the ...
How would you approach an isolated prostate recurrence of high-risk prostate cancer following definitive EBRT?
It is important to know: 1) time from cessation of hormones and time to recurrence. Better to also have T levels. 2) velocity of PSA rise. 3) absolute PSA value Longer disease free interval, slow PSA kinetics and low PSA suggests prostate only recurrences. I have also begun to incorporate Aximun s...