Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you initiate vaginal cuff brachytherapy treatment after hysterectomy for early stage endometrial cancer?
We usually start vaginal cuff treatment 5-6 weeks after hysterectomy. If adequately healed, may start at 4 weeks but not before. Rarely more than 8 weeks. For patients receiving vaginal cuff treatment plus chemotherapy, we still give cuff treatment within 6 weeks. There is no reason to delay because...
What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?
Dexamethasone is one of the most frequently prescribed medications in neuro-oncology clinics. Dexamethasone is often favored over other corticosteroids owing to its lower mineralocorticoid effects and high potency as well as essentially 1:1 oral to IV ratio meaning that we use similar IV and oral do...
When treating endometrial cancer patients with a combination of chemotherapy and vaginal cuff brachytherapy, when do you deliver cuff brachy?
I prefer, most of the time, between the cycles of chemotherapy (1 to 3) based on logistics.
What fractionation would you offer to a young pre-menopausal woman with early stage ER+/HER2- breast cancer who received adjuvant chemotherapy and is highly interested in maximizing breast cosmesis?
40 Gy in 15 fractions with focus on dose homogeneity aiming for V105 < 5%.
Given the results of LU002 presented at ASCO 2024, are there situations and/or patient subgroups who still derive benefit from local consolidative therapy for oligometastatic NSCLC?
This is a tricky trial to interpret. They allowed a mixture of "stage I" primaries with oligomets and "stage III" locoregional disease with oligomets. The former got SBRT to the primary and the latter got 45 Gy/15 fx to primary and involved LN. There is a huge difference in the "ablativeness" of tho...
In a patient with prior RT to the prostate and SVs and newly diagnosed, locally advanced rectal cancer at 10-15 cm, would you offer preoperative chemoradiation?
"Locally advanced" rectal cancer was traditionally described as T3/4N0M0 or TxN+M0 cancer, but we have advanced much farther on the characterization of this now.We also know that the local control of patients undergoing resection for high rectal cancer (10-15 cm from the anal verge) is much better t...
How do you counsel glioblastoma multiforme patients on which types of clinical trials to pursue?
This is a great question! In general, I think that a clinical trial gives someone access to promising therapies (and of course glioblastoma is an aggressive tumor for which we have no cure), but enrolling in one may not feel like the right decision for all patients (for a variety of reasons). I thin...
How would you treat a patient with ER/PR positive breast cancer with a single site of bone metastasis?
I would still treat with hormone therapy and a CDK 4/6 inhibitor. Not clear if the question refers to denovo disease or not. I generally do not treat asymptomatic bone mets with radiation, as there are late effects in patients who have a relatively long life expectancy and no data to suggest that ra...
In what circumstances would you consider use of IDH inhibitors in high-grade astrocytomas?
Please forgive me for the length and directness of my response, but I believe it is important to first go over the INDIGO trial and explain why, in my opinion, it was a highly questionable study, with multiple significant methodological flaws and dubious evidence of Vorasidenib's efficacy.INDIGO tri...
How do you manage a spinal intramedullary metastasis following resection?
Complete surgical removal (gross total resection) of an intramedullary metastasis may not be possible without damaging normal spinal cord tissue, especially for more infiltrative tumors. Postoperative radiation therapy is therefore used to treat any residual tumor cells that were left behind to pres...