Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you define your treatment volumes when treating a patient with post-mastectomy radiation therapy?
There are several ways to define treatment volume with PMRT. 1) The way that I have handled these cases is to wire out the chest wall and chest wall scar at sim and use this to create my treatment volumes rather than contouring. If the drain site is in the volume I cover it but otherwise dont extend...
How would you manage a prolonged treatment break in the middle of lung SBRT for early stage NSCLC?
I’ve never had this particular scenario occur but I likely wouldn’t change total dose or fractions unless we are talking about an essentially new course type of delay. Not lung but there is data from the University of Michigan in 2019 looking at an intentional 4-week break after fraction 3 of SBRT f...
How do you approach Lu-177 use in taxane-naive patients with metastatic prostate cancer?
At this time in October 2024, Lu177-PSMA-617 is not yet approved in taxane-naive mCRPC, and decisions on its use and availability hinge both on USFDA approval in the coming months as well as NCCN guidance, which has not been updated at this time. Until then, decisions to pursue this radioligand ther...
For a patient who has vaginal cuff recurrence <6 months after adjuvant pelvic radiotherapy to a dose of 45 Gy, how would you approach management?
If amenable to a potentially curative brachytherapy approach, I would generally want to do this first and then give systemic treatment. The risk of local progression during systemic treatment is significant, and if this occurs, the patient has often lost the chance to be cured. However, if the decis...
How do you sequence ADT relative to the start of RT?
Happy New Year to the MedNet! This is a great question that should remind us to question everything. This is an important question that the prostate community I have felt since I was in training has over simplified for decades. First: Our current nomenclature has problems. Most residents and facult...
Do radiation oncology missions to developing countries actually provide a means for sustainable cancer care?
The cancer burden is large and growing in developing countries. In many parts of the world, cancer awareness is low and currently available infrastructure is insufficient to support the growing burden of cancer. For many years, cancer was thought to be a disease of affluent countries. With the impro...
Is there still a role of brachytherapy in uterine cancer if intensity-modulated radiation therapy is available?
Yes. Brachytherapy is still more conformal than optimally planned IMRT.
Do you ever treat regional lymph nodes for malignant phyllodes tumor of the breast?
I have not treated regional nodes in malignant phyllodes cases, even in larger tumors.
How does the recently published SOUND Trial affect your approach to breast RT?
This is a great question. Some radiation details were given in the SOUND trial. We know that ~98% of women in both arms got radiation. The vast majority of patients got whole breast radiation (84% in the SLNB group and 81% in the no axillary surgery group) and a smaller group got PBI with IOERT (~11...
Do you have a size cutoff for liver SBRT?
I favor SBRT for lesions <5 cm, highly select cases between 5-7 cm with favorable anatomy in a relatively large liver (not common in my practice), and are distanced from the central biliary tree/porta (i.e. >1-2 cm). For cases that do not meet these criteria or for which reasonable liver constraints...