Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you reconcile discordant PSMA and MRI findings in patients undergoing definitive radiotherapy for prostate cancer?
In the situation wherein you found something on PSMA PET that wasn’t seen on MRI, I would obtain a biopsy for 2 reasons: 1. In order to confirm the presence of distant metastasis or 2. If tissue is needed for genomic testing. Otherwise, I would not biopsy in the case of discordant imaging, since I w...
Would you consider long course pelvic CRT after neoadjuvant chemotherapy in a patient with low lying, locally advanced rectal adenocarcinoma when you're unable to meet small bowel constraints?
I would definitely offer long course chemoradiation in this setting. The V15 small bowel is not a constraint that should be used to determine treatment. The only absolute constraint I use for pelvic chemoradiation for rectal cancer is a small bowel maximum dose of 55 Gy. The 55 Gy maximum dose const...
Are there circumstances when you would consider re-irradiation of the esophagus in a patient who is not a surgical candidate or declines surgery?
Reirradiation of the esophagus is something that comes up infrequently, but consistently in esophageal cancer patients treated with radiation. There are multiple specific scenarios, with various levels of risk. There are multiple options available, and there is not prospective data comparing these o...
In light of de-escalation data, for patients undergoing standard dose radiation for favorable HPV + oropharynx cancer, do you accept lower coverage of the low-dose RT field to better spare OARS?
I do not compromise PTV coverage to spare non-critical OARs in patients treated with curative intent for head and neck cancer. What is important to consider (and what I suspect this question may be getting at) is that dose and target selection are critical to reducing the dose to non-critical but fu...
What dose-fractionation would you recommend for a small basal cell carcinoma of the nasal ala in a patient with poor performance status or transportation difficulties?
This patient appears to be an excellent candidate for HDR brachytherapy. An appropriately selected surface applicator (Leipzig or Valencia) may be advantageous compared to electrons by allowing for homogeneous dose distribution to a small area conformality to an irregular/curved surface shallow dos...
What dose and volumes do you use for incompletely resected WHO grade II meningiomas with brain invasion?
I agree with Dr. @Dr. First Last and find his approach both reasonable and wise. Permit me to review variations in target volume definition between the RTOG-0539 and NRG BN003 trials, and explain how I have approached patients with incompletely resected WHO grade II meningioma with brain invasion.Th...
Would you use short course radiation for patients with rectal cancer and ulcerative colitis or Crohn's disease?
Patients with active inflammatory bowel disease have an increased risk of acute and late toxicities after radiation. Wound healing can be delayed. Due to the fact that most patients that were treated with short course in the past have had immediate surgery before the acute reactions even occur and i...
How would you deliver/time radiation for a patient with IIIC1 serous endometrial cancer who is HER2+?
Stage III (particularly IIIC) and serous histology are both risk factors for distant failure. In combination, the patient is at an even higher risk. Therefore, I would prioritize getting in all cycles of chemotherapy to maximize distant control; generally, this would comprise 6 cycles of carboplatin...
How would you treat an MMR-proficient T2 N0 low-rectal cancer (measuring 2 cm extending 4-6 cm from the anal verge) in a patient who wishes to preserve his sphincter?
Thanks for the question. I think a multidisciplinary approach is key here. First, I would make sure there is an MRI rectal performed confirming the stage of cancer and also clarify whether the patient would like to have organ preservation approach (not only the sphincter but also the rectum itself)....
Do you apply an ipsilateral lung constraint for conventionally fractionated lung RT?
To my knowledge, there is limited data in the setting of lung cancer that informs ipsilateral lung constraints, outside of mesothelioma protocols. One study by Ramella et al., PMID 19619955 described an ipsilateral V20 of 52% and V30 of 39% as predictive of grade 2 or higher pneumonitis for patients...