Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you mange true anal margin squamous cell carcinoma (with no involvement of anal canal) if wide local excision cannot be done and chemoradiation therapy is being used instead?
There are many facets to this question. First, it is critical to know that this is a surgical disease, and radiation therapy should only be used as a last resort. If there is no involvement of the anal canal, that strengthens the argument for the use of surgery. The situation is rare when radiation ...
How do you assess whether a patient is suitable for prostate SBRT?
At UCLA, we do not routinely use a prostate volume/size threshold when considering whether a patient is a good candidate for SBRT or not. There are data from the Georgetown group that suggest that men with prostate volumes ≥50 cm3 may have slightly increased acute grade ≥2 GU toxicity; these res...
How do you treat inoperable T1-2N0 apical lung cancers near the brachial plexus but without extension outside the lung?
This is a challenging question, and there are certainly a range of reasonable answers. I would agree with @Dr. First Last that the Forquer/Timmerman paper establishes there is significant risk of plexopathy when exceeding 24-26 Gy in 3 fractions. On the other hand SBRT offers superior local control ...
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 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...