Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider simulating a patient with brain metastases in the prone position if they are unable to tolerate lying supine for SRS treatment?
I have taken care of many sick and quite comorbid patients with brain metastases and have not yet run across the situation - mainly because someone with poor enough performance status that they cannot tolerate a supine positioning awake, or under anesthesia, is typically not an ideal radiosurgery ca...
Is there a risk of increased side effects with combined radiation and ibrutinib therapy?
It is increasingly common to see patients with various hematologic malignancies requiring palliative RT who are on small molecular inhibitors (such as ibrutinib) or other novel agents. There is often a dearth of information in the medical literature regarding the safety of combining RT with these dr...
How would you manage simultaneous locally advanced NSCLC and locally advanced head and neck cancer?
Agree with Dr. @Dr. First Last, however, if planning to treat these synchronously, I would favor two setups, one for lung and one for HN. I would want to keep doses in lung tight to minimize toxicity as much as possible. Having to fight with arms and butterfly arcs is going to make that much tougher...
What radiation dose is a risk for damaging function or active leads from a pacemaker?
This is a complex issue sometimes asked on our weekly OLA/ABR website. According to the updated 2019 AAPM TG-203 report published in Medical Physics by Miften et al., PMID 31571229, and the JACC review by Fradley et al., PMID 34604807, care for patients with CIEDs requires careful attention to indiv...
How do you sequence thoracic consolidation RT and PCI with incorporation of immunotherapy in ES-SCLC?
In the IMpower133 study, "during the maintenance phase, prophylactic cranial irradiation was permitted as per local standard-of-care, but thoracic radiation with curative intent or the intent to eliminate residual disease was not permitted. Palliative thoracic radiation was allowed. (quoting from th...
How do you incorporate PCI into your management of patients with extensive stage SCLC?
The role of prophylactic cranial irradiation (PCI) in the modern era of brain MRI surveillance has been called into question and is the topic of the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- PCI (or hippocampal avoidance [HA]-PCI) for LS and ES-SCLC, where I serve as the prin...
Do you take the primary dissected site for postoperative oral cavity cancers with bony invasion to 66 Gy?
Dr. @Dr. First Last correctly addresses the nuanced indication for PORT due to bone involvement.60 Gy is embedded in the PORT culture. For at least 30 years, RTOG trials have recommended 60 Gy with an optional boost to 66 Gy for PORT, though the EORTC trial (Bernier et al., PMID 15128894) went to 66...
What prostate size, if any, is a relative contraindication for external beam RT?
I do not view the prostate size itself as a contraindication on its own to EBRT. I believe the largest prostate I have treated was ~350 cc. The things to keep in mind when treating any prostate patient, but especially when gland sizes are large, are: 1. How well was the gland sampled? MRI can be ver...
How does the presence of interstitial lung disease affect your decision to offer SBRT for early stage NSCLC?
As opposed to interstitial lung disease (ILD) in general, the entity most described in the literature as associated with severe pulmonary toxicity after SABR has more specifically been idiopathic pulmonary fibrosis (IPF) and additionally, in the absence of a known diagnosis of IPF, CT findings consi...
Do you ever start patients on a Friday if non-emergent and you're not treating over the weekend?
The data for reducing radiation treatment time/elapsed days are most obvious in the setting of squamous cell carcinomas (SCC), where data have shown in H&N cancers, cervical cancers, and anal cancers that shorter treatment times are important for optimal local control. One study that I find intrigui...