Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you decide the right time to transition to hospice?
Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor in ...
What are your top takeaways in Breast Cancer from ASTRO 2024?
There were a number of important presentations on breast cancer at the ASTRO 2024 meeting. The three randomized trial discussed below stood out.1. Abstract 1: Poppe MM, et al.: A randomized trial of hypofractionated post-mastectomy radiation therapy (PMRT) in women with breast reconstruction (RT CHA...
Does a genetic predisposition to cancer affect your recommendations regarding breast conservation and radiation?
The question posed makes the assumption that radiation should be avoided in ATM, BRCA, and p53, and asks about other genes. I would begin by stating that radiation should not necessarily be avoided in the vast majority of patients with genetic variants or mutations, even those referred to in the que...
How would you treat an elderly patient with squamous cell carcinoma of the anus who is not a chemotherapy candidate?
It's a suboptimal situation because chemotherapy improves relapse-free and colostomy-free survival, and possibly overall survival for all but the earliest stage patients. I would look into whether capecitabine alone might be an option as a radiosensitizer that might be more tolerable than mitomycin-...
When would you consider testicular RT prior to TBI for BMT?
In children with ALL treated with systemic chemotherapy alone (no transplant), the risk of testicular recurrence is ~15-20% (Br J Haematol 2003;123:396, Br J Haematol 1998;102:656). In adults with AML treated with standard chemotherapy, with or without transplant using a chemotherapy alone condition...
How do you use Boswellia for radiation necrosis?
I reached out to my colleague, naturopath Lise Alschuler, Associate Director of the University of Arizona Fellowship Program in Integrative Medicine program, for her thoughts on this question. Here is her answer:This study by Upadhyay et al. is a well-designed study which builds upon earlier studies...
Do you routinely recommend consolidative radiation to bulky site(s) in the setting of advanced stage DLBCL?
How radiation therapy (RT) should be incorporated into the management of patients with advanced DLBCL continues to be investigated. In the setting of widespread, non-bulky disease, when a complete response is achieved with systemic therapy, I don't recommend consolidation RT. Though controversial, I...
In what situations do you order an Oncotype DX DCIS score for a patient with DCIS?
This is an excellent question. I suspect there will be many takes on this question since there is considerable controversy about omitting RT for DCIS in general. Here's what I think we know.Let's review the clinical data from the Oncotype Dx DCIS Score.1) Solin L et al JNCI 2013: A subset of the pat...
Should SBRT for bone metastasis be delivered daily, or every other day?
Canadian/Australian study gave 24 Gy in 2 fractions on consecutive days and no excessive toxicity was noted.I schedule them daily, but if there is a patient convenience issue, QOD is reasonable.It is very interesting, however - there is conflicting data on the efficacy of QD vs QOD for SBRT for lung...
How do you explain the risks and benefits of palliative radiation therapy to patients with fungating breast masses?
The value of palliative RT in these patients is to dry up oozing and bleeding and RT is very effective in achieving that goal. I have had success in these patients almost all the time and my usual dose is 30-39 Gy in 10-13 fractions.This study gives a prospective dataset for fractionation and pallia...