Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When offering APBI, if a patient has invasive ductal carcinoma and DCIS, do they need to fill suitability criteria for both, or does the DCIS criteria only apply to pure DCIS?
In such cases, I use the criteria for invasive cancers. I only use DCIS criteria for pure DCIS.
What dose of reirradiation would you consider for locally recurrent breast cancer after mastectomy, excised with positive margins?
These are complex cases and lots of factors to consider when planning adjuvant therapy (age and comorbidities, tumor biology, other pathologic features like LVI, reason for the positive margin, plans for systemic therapy, presence of reconstruction, the volume of prior radiation, extent of clinicall...
In the setting of recurrent breast cancer after breast radiation, who receives a mastectomy and is found to have positive axillary nodes, under what circumstances would you give radiation to the chest wall and nodes vs the nodes only?
There is no absolute answer, and it is a function of time to recurrence, previous volume of RT, and potential benefit of RT (based on extent and location of recurrence and phenotype of disease). The threshold to treat is higher than upfront setting for sure. Treatment can vary from none to comprehen...
Do the results and approval based on ADAURA trial suggest a role for adjuvant osimertinib in patients with stage IIIB-C, EGFR mutant patients treated with concurrent chemoradiation?
ADAURA trial was not designed to address this issue. But that being said, we need to remember few things before considering "maintenance durvalumab" in patients with EGFR-mutant lung cancer, following chemo-radiation: 1. EGFR-mutant NSCLC patients may not derive any clinical benefit from single-agen...
When, if ever, would you consider hippocampal avoidance whole brain radiotherapy in the setting of leptomeningeal disease?
Never. Unless it is nodular leptomeningeal disease recurrence after surgical resection.
When utilizing hypofractionation for postmastectomy radiation, what is your strategy for boosting undissected nodes?
2.5 x 4 to 5. Fractions based on the response of the undissected node to systemic treatment.
Has the PACE-A sexual function data changed how you present treatment options to a patient with localized prostate cancer who prioritizes preservation of sexual function?
There is limited available data comparing patient-reported outcomes (PROs) between stereotactic body radiotherapy (SBRT) and prostatectomy in localized prostate cancer. The PACE-A Trial is a randomized controlled trial comparing SBRT to radical surgery for low- to intermediate-risk prostate cancer. ...
What are best practices for taking care of lung cancer patients during the COVID-19 pandemic?
This is a great question, and as always there is no one size fits all. For patients on active treatment for lung cancer such as chemoimmunotherapy, I continue to stress the importance of hand washing, social distancing, and to work on reducing wait times in the waiting room to limit exposure, etc. I...
How should dose homogeneity across bone be handled in pediatric patients?
The radiation-associated bone damage can be affected by many factors, including total radiation dose, fractionation schedule, treatment volume, age of the child, symmetry of the delivered dose over vertebrae, developmental status of the irradiated growth plates, treatments such as chemotherapy or su...
Do you recommend IM biopsy in the initial staging of breast cancer patients with suspicious IM nodes on imaging?
I think it is always preferable to biopsy suspected cancer sites when developing a therapeutic plan. Biopsy provides a greater degree of certainty in clinical decision making and can be informative when evaluating outcomes of care retrospectively for quality improvement or research projects. However...