Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does radiation therapy (ex. to the breast) in patients with CDK4 mutations increase the risk of developing melanoma?
I am unaware of any literature supporting the fact that RT in patients with CDK4 mutations increases the risk of melanoma development. There have been studies, with conflicting results though, looking at whether there is any increased risk or incidence of melanoma in patients with breast cancer wh...
What vertebral body dose constraint do you use in SBRT to limit compression fracture?
Vertebral body compression fracture after stereotactic radiation is a complicated topic with multiple contributing factors. Different institutional analyses have demonstrated lytic tumors, bony involvement by tumor >40%, age >55, pre-treatment pre-existing fracture, histology, spine deformity, and d...
What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?
I am a radiation oncologist and palliative care physician.I teach: "the hand that writes the opioids, writes the laxatives - or else it does the disimpaction". Opioid induced constipation is very common, can cause physical and psychological discomfort, and have a major impact on quality of life. It ...
What is the optimal treatment of medically inoperable T3N0 non-small cell lung cancer that is too large for standard SBRT?
As we see it, there is more than one way to skin the cat. RTOG 0617 has condemned protracted fractions to 70 Gy...it just might be that 70 Gy is the wrong way to treat in 35 fractions, +/- cetuximab added to weakly carbo taxol. But the study to look at thoracic dose is contaminated by those systemic...
What duration of ADT do you recommend for a patient with locally treated prostate cancer who undergoes metastasis-directed radiation therapy to a single oligometastatic bone lesion?
While I agree with @Dr. First Last that very small studies like STOMP and ORIOLE suggest that a small subset of men can delay the need for ADT by 1-3 years, this is not level 1 evidence. Most men with oligometastatic HSPC will still progress with metastasis directed therapy alone over a short time h...
What factors, if any, (such as microscopic ENE (<=2 mm) or larger nodal size (e.g., >4 cm)) would prompt you to treat the contralateral neck for oropharyngeal cancers otherwise eligible for unilateral radiotherapy?
BOT primary that are not very lateral, as well as tonsillar ca involving the palate, have potential contralateral lymphatics, and contralateral neck RT should be considered. The ipsilateral RT series in the IMRT era are still small. The classical large OSullivan study included few patients with N2b ...
How would you approach a patient with synchronous HPV-mediated bilateral tonsil primary with ipsilateral lymph nodes who cannot receive chemotherapy?
We address this type of scenario in the guideline published last year in PRO Margalit et al., PMID 39078350. I hope the explanations there are useful, but to summarize, in the MARCH meta-analyses, most altered fractionation types improve locoregional control, but only hyperfractionation (often 1.2 G...
Is it acceptable to offer 26 Gy in 5 fractions for APBI rather than whole-breast RT?
Yes. We know 26/5 works for whole breast, either daily or weekly fractionation schedules. So, one can utilize that in patients that are APBI candidates. That being said, the toxicity data from Florence trial and my personal experience are excellent, so I do a hybrid approach. I give 26/5 to a larger...
What is a safe and effective ablative dose and fractionation for oligometastasis to humeral head or femoral neck from lung cancer with controlled disease elsewhere?
This is becoming a more common clinical scenario with the improvements in systemic therapies and growing bodies of literature supporting the utility of SBRT as a metastasis-directed therapy. A practice pattern analysis of non-spine bone SBRT dose prescriptions and treatment planning was recently pub...
What is the minimum number of hyperbaric oxygen treatments you would prescribe for late radiation toxicities?
The RICH-ART Trial from 2019 In Lancet Oncology (Oscarsson et al., Lancet Oncol 2019) utilized 30-40 sessions with good effect. We have typically used a similar protracted treatment schedule for RT cystitis, but I would be curious if others have had success with shorter schedules.