Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage a recurrent brain metastasis in a surgical cavity that contains mixed radiation necrosis and viable tumor in the setting of prior SRS?
This diagnosis is made at our center by combining MRI, MR perfusion, and PET data. Management depends on the presentation of the patient, if there is mass effect and/or neurological deficit then surgical re-resection is preferred. As a matter of interest, the pathology on the infrequent resections d...
What SBRT dose do you recommend for an oligomet of the lung from prostate ca?
No reason not to go with standard >100 BED approaches (54/3, 48-50/4, 50/5, 60/8), as we don't necessarily have prospective data for prostate cancer specifically.
What dose/fractionation would you recommend for a large brainstem metastasis?
This is always a difficult clinical decision; for "large" (however one chooses to define this) pontine/medullary/brainstem mets, most have moved away from single fraction SRS to 3 fraction SRS (27 Gy in 9 fractions), based largely on the results of the Italian trial. In this trial, 289 patients with...
Would you use triplet chemotherapy FLOT in lieu of chemoRT for patients with localized esophageal squamous cell carcinoma?
This is a timely question in esophageal SCC (ESCC), even as we adjust to the now markedly diminished role of pre-operative chemoradiation vs. FLOT in esophageal/GEJ adenocarcinoma, based on the recent phase III ESOPEC study [Hoeppner et al., ASCO 2024; LBA1] (as well as the NeoAEGIS study that prece...
Is whole body phototherapy for skin disorders a contraindication to chest wall or breast radiation?
I would not consider prior phototherapy a contraindication. I regularly treat patients with cutaneous lymphomas and occasionally, refractory dermatitis after phototherapy, mostly narrow band UVB. Some of them have received maintenance phototherapy for 1-2 years before treatment with significant skin...
How do you treat adrenal metastases with SBRT?
Adrenal glands move quite a bit with breathing. I would strongly recommend some form of motion management, either with breath hold, or 4DCT with abdominal compression, (the latter of which is my personal preference). I draw GTV (just tumor, not entire adrenal gland) as defined on whatever imaging sh...
What is the best SBRT dose-fractionation scheme for oligometastatic disease in the adrenal gland?
I don't think we have established a true "best" SBRT dose-fractionation schedule for any anatomical site, even the common ones where we have randomized trials comparing different dose regimens (ie lung), as the volume of data provides successful and acceptable alternatives but not necessarily a defi...
Does the presence of LCIS on pathology in a patient with IDC impact your decision to offer APBI?
It doesn’t change the decisions for APBI with all other factors being favorable. We offer APBI to invasive lobular also if it meets all criteria and had MRI breast done as part of the evaluation.
How would you manage a solitary, painful, lytic bony lesion in a patient with negative PET/CT but bone marrow biopsy confirmation of multiple myeloma?
This is a palliative scenario, but the approach may differ based on the clinical circumstances. If Heme Onc is planning on administering systemic therapy, then a short course of palliative RT to expedite pain control would be appropriate. Treatment of many sites (e.g., femur) can be done very quickl...
What, if any, radiation regimen would you use for knee arthrofibrosis in a patient undergoing repeat arthroscopy with lysis of adhesions?
The high-dose single fraction regimens seem to be adapted from heterotopic ossification protocols and would be my choice if there was a concern for HO. If the concern is for the reaccumulation of fibrotic tissue, I favor LDRT such as 0.5 Gy 2-3 doses weekly for 6-8 fractions. There will be more sust...