Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How can you manage a patient with bilateral PCNs who requires Pluvicto administration?
We've treated several of these folks. In general, we ask the patients to ensure they are emptying the bags frequently for the first three days to minimize the volume of urine next to the skin. There have been reports of radiation dermatitis from Foley/PCN bags that are left in the same spot against ...
Would you offer neoadjuvant chemotherapy prior to trimodality therapy in a fit patient who refuses surgery for muscle-invasive bladder cancer?
Unfortunately, this is a question without a clear answer at this time. Trimodality therapy, consisting of maximal TURBT, chemotherapy, and radiation, appears to have equivalent outcomes and has NCCN Category 1 recommendations for patients with MIBC. We do not routinely do neoadjuvant chemotherapy fo...
How do you treat a patient with early-stage breast cancer s/p lumpectomy and oncoplastic reconstruction with a positive margin, when re-excision is not feasible?
It depends on the level of oncoplastic surgery done. If level 1, we can identify the surgical site and can boost after whole-breast RT of 26 in 5 or 40 in 15. If level 2 or 3, then just increase the whole breast dose to 42.5 in 16, as we can’t identify the boost area.Han et al., PMID 40024440
Are you offering Lutathera for multiple recurrent meningiomas?
Lutathera is currently only FDA-approved for treating somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, research is ongoing to explore its potential use for meningiomas, as many meningiomas express somatostatin receptors, which could make it a promising...
What dose constraints do you use for 60 Gy in 15-20 fraction lung treatments that are adjacent to the hilum?
The LUSTRE trial, which is a Canadian RCT comparing SABR (60/8, 48/4) vs. 60/15 provides some max point constraints to address this for 15#. Swaminath, Clin Lung Cancer. 2017 Mar;18(2):250-254. Spinal Canal 36 GyEsophagus 48 GyBrachial Plexus 50 GyHeart 66 GyGreat Vessels 66 GyTrachea/PBT 66 GySkin ...
What is the optimal interval between vaginal cuff brachytherapy sessions?
At MD Anderson, we give 6 Gy x 5 to the surface and we most often treat every other day. However, given the low risk of toxicity, we think it's safe to make adjustments to this schedule. For example, we often do some treatments on sequential days if that's preferred for any reason. We also schedule ...
How do you manage a prostate cancer patient with pelvic lymphadenopathy and a single enlarged PSMA PET+ gastrohepatic node?
I would treat it as oligometastatic, starting with ADT/ARPI and use metastasis-directed therapy and pelvic radiation.
Do you consider increased tumor thickness alone as an indication for postoperative radiation in oral cavity cancers?
Depth of invasion (DOI )has been shown to predict regional disease. As such, surgeons will use this information to decide if a neck dissection (ND) should be performed in the cN0 patient with oral tongue cancer.With no other adverse features (i.e., no PNI, no LVSI, no poor differentiation, good marg...
In ES-SCLC presenting with extensive brain metastases, how do you time whole brain radiation after the first cycle of chemotherapy has already been delivered?
We typically try to wait as long as possible before we start WBRT. It depends on the burden and symptomatology of intracranial disease as well as the initial response to chemo-immunotherapy. If the brain metastases are asymptomatic and deemed OK to monitor closely (i.e., not likely to cause neurolog...