Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What cumulative dose would you allow the pharyngeal carotid to receive for a course of reirradiation for a retropharyngeal node?
No dosimetric data available. I don't use a carotid OAR in my cases, and just ensure the disease is appropriately covered, while limiting cord/brainstem primarily.From the literature, highest risk cases are those with skin involvement (ie tumor from skin to carotid). Risk of 1-5% for carotid blowout...
Would you treat a NSCLC with a hypofractionated course daily or every other day?
The rationale for every other day dosing dates back decades, but in the SBRT/SABR space was perhaps most clearly demarcated for most of us in the RTOG 0236 protocol. In this study, when delivering 54 Gy/3 it was stated that "A minimum of 40 hours and a maximum of 8 days should separate each treatmen...
What adjuvant treatment would you recommend for a patient with FIGO 2023 IIIB2 endometrioid endometrial adenocarcinoma (Grade 3, p53mut, MMR proficient), metastatic to the uterine serosa, bilateral ovaries, and anterior peritoneal reflection?
Chemotherapy followed by pelvic RT
What are your top takeaways in Radiation Oncology from SABCS 2024?
Wine regions have good years and bad years. This year's vintage from San Antonio was exceptionally fine, with oral presentations of several important, highly anticipated trials. The second and third of the studies I will discuss were also published on the day of the oral presentation.1. GS2-03: Kunk...
What electron beam dose/fractionation would you use for a recurrence basal cell carcinoma of the scalp adjacent to a split thickness skin graft?
Standard curative dose and fractionation, 6e and 1 cm bolus if superficial lesion, assuming complete healing of the surgical scar.
Would you include the internal mammary nodes (unilateral or bilateral) in the adjuvant radiation field for a small Merkel cell carcinoma located along the sternum on the medial chest wall, s/p R0 resection, but no sentinel lymph node biopsy?
I would consider including adjoining ipsilateral IMN in the volume.
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
Do you need to hold Humira (adalimumab) during radiation for breast cancer in a patient with psoriatic arthritis?
To my knowledge, there is not a lot of data on the interaction of adalimumab or other similar meds and radiation therapy. I am increasingly seeing this in my practice, however, for patients with psoriatic or rheumatoid arthritis. I discuss with patients that we have limited data on potential interac...
For vaginal cuff recurrence of an endometrial cancer, when do you utilize a multichannel cylinder versus single channel cylinder if a patient has <5 mm residual disease after EBRT?
If disease is confined to one wall, favor MC applicator as I treat vaginal wall thickness for side involved while surface on other side. MC allows that flexibility.Here is the link to our publicationGebhardt et al., PMID 29929925
Would you treat an inoperable <5 cm NSCLC tumor involving the hilum with SBRT?
There is legitimate concern with the development of late toxicities such as bronchial stenosis and hemopytsis after SBRT for centrally located tumors. The recently updated data from RTOG 0813 confirms that even with early stage, node negative, centrally located tumors, there is an approximately 5% r...