Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage incidentally-found prostate cancer on TURP?
The patient's risk group along with genomic classification with Decipher would inform the treatment recommendation regardless of the source of the tissue. The pathologist should be able to estimate how much of the tissue had cancer and provide the Gleason Group. The location and volume of tissue are...
Would you recommend definitive XRT for prostate cancer in patients with prior Holmium Laser Enucleation of the Prostate (HoLEP)?
There are multiple options for outlet procedures in patients who present with baseline obstructive symptoms but prefer to avoid a radical prostatectomy. HoLEP is an effective procedure preferred by some urologists due to low re-treatment rates. HoLEP can often be quite aggressive leading to marked r...
How would you approach a patient with early-stage orbital MALT lymphoma with high proliferative index?
High proliferative index is uncommon in MALT lymphoma, seen more often with high grade histologic variants. For localized disease, it would not influence my management recommendations. For orbital MALT lymphoma, 24 Gy in 2 Gy fractions to the orbit. Efforts to shield part of the orbit should be unde...
If using 26-fraction moderate hypofractionation, what dose do you use for the intraprostatic dominant nodule SIB?
The definition of a nominal prescription dose for a focal boost is a confusing topic as often times the coverage at a given prescription dose is outside the realm of what is usually considered a valid prescription dose (i.e., coverage at a requested prescription dose is < 95%), and a prior thread al...
Would you have a patient temporarily discontinue methotrexate while receiving a FAST or FAST FORWARD regimen for breast irradiation?
I favor continuing as the dose of MTX is low for RA and in CMF era with much higher methotrexate dose, RT plus MTX was well tolerated.
How do you approach EGFR mutated NSCLC with isolated progression in the chest who is planned for a course of radiation at least 3-4 weeks?
This is an interesting question without a clear answer. There are two competing risks associated with either decision. The risk of continuing osimertinib while radiating chest disease is clearly that of pneumonitis with the overlapping risks from radiation and osimeritinib. The risk of holding osime...
When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?
I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity. The main thin...
Would you offer adjuvant radiotherapy for a gross totally resected WHO grade 2 hemangiopericytoma/MFT of the brain in a patient with active multiple sclerosis?
This is a tough question to answer, as there are risks associated with either recommending post-operative radiotherapy or not. Hemangiopericytomas are rare intracranial tumors that arise from pericytes, support cells found in the wall of meningeal capillaries. They are part of a larger spectrum of m...
What are the indications for adjuvant RT following resection for intracranial hemangiocytomas?
Hemangiopericytomas (HPC) are rare and challenging tumors affecting mostly the brain.The primary approach is a safe complete resection (GTR) but this is not always feasible as in the case in question. HPC is considered part of a spectrum with solitary fibrous tumor (SFT), with HPC representing a mor...
How do you approach the management of an early stage non-small cell lung cancer limited to an endobronchial location (non-obstructing) in a patient that is not considered operable due to medical comorbidities?
The use of SBRT is predicated on CT based imaging so that a physical and visible target can be delineated and for which a radiotherapy plan can be generated. For patients where no such imaging-definable lesion has been identified, as with for example, an endobronchial-only lesion noted at the time o...