Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
If using 26-fraction moderate hypofractionation, what dose do you use for the intraprostatic dominant nodule SIB?
The definition of a nominal prescription dose for a focal boost is a confusing topic as often times the coverage at a given prescription dose is outside the realm of what is usually considered a valid prescription dose (i.e., coverage at a requested prescription dose is < 95%), and a prior thread al...
Is there any evidence that ivermectin suppresses the PSA level in prostate cancer?
Is this even the right question, though? ADT drops PSA very reliably and yet does not cure patients. Finasteride suppresses PSA, but we do not use it as a mainstay of cancer treatment. Even if ivermectin *did* suppress PSA, unless there is a meaningful oncologic benefit (*at least* reduced recurrenc...
Would you have a patient temporarily discontinue methotrexate while receiving a FAST or FAST FORWARD regimen for breast irradiation?
I favor continuing as the dose of MTX is low for RA and in CMF era with much higher methotrexate dose, RT plus MTX was well tolerated.
How do you approach EGFR mutated NSCLC with isolated progression in the chest who is planned for a course of radiation at least 3-4 weeks?
This is an interesting question without a clear answer. There are two competing risks associated with either decision. The risk of continuing osimertinib while radiating chest disease is clearly that of pneumonitis with the overlapping risks from radiation and osimeritinib. The risk of holding osime...
When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?
I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity. The main thin...
Would you offer adjuvant radiotherapy for a gross totally resected WHO grade 2 hemangiopericytoma/MFT of the brain in a patient with active multiple sclerosis?
This is a tough question to answer, as there are risks associated with either recommending post-operative radiotherapy or not. Hemangiopericytomas are rare intracranial tumors that arise from pericytes, support cells found in the wall of meningeal capillaries. They are part of a larger spectrum of m...
What are the indications for adjuvant RT following resection for intracranial hemangiocytomas?
Hemangiopericytomas (HPC) are rare and challenging tumors affecting mostly the brain.The primary approach is a safe complete resection (GTR) but this is not always feasible as in the case in question. HPC is considered part of a spectrum with solitary fibrous tumor (SFT), with HPC representing a mor...
How do you approach the management of an early stage non-small cell lung cancer limited to an endobronchial location (non-obstructing) in a patient that is not considered operable due to medical comorbidities?
The use of SBRT is predicated on CT based imaging so that a physical and visible target can be delineated and for which a radiotherapy plan can be generated. For patients where no such imaging-definable lesion has been identified, as with for example, an endobronchial-only lesion noted at the time o...
For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?
This is a common clinical question that has been repeatedly explored in meta-analyses and clinical guidelines. Consistently, there's no evidence to support primary prophylaxis for seizures in patients with brain tumors including brain metastases. In summary, the data does not support the routine use...
Would you offer adjuvant radiotherapy for a malignant fibromyxoid tumor of soft tissue with margin < 1 cm on re-excision?
Malignant ossifying fibromyxoid tumors are very rare and from a pathologic perspective, often get lumped under the tumors of intermediate malignant potential and of uncertain differentiation category. The expectation that the histologically malignant fibromyxoid tumors behave malignant, and thus I w...