Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Which early-stage breast cancer patients who are candidates for 3-week hypofractionated whole breast EBRT are not good candidates for 1-week whole breast EBRT?
One important dosimetric criteria for 5.2 x 6 is V105 of 5% or less and v 107 of 2% or less. For 3-week RT, our data suggest v105 < 10% caused less morbidity. These dose homogeneity constraints are sometimes hard to meet for moderate or large size breasts, and one needs to be careful. Also, if a bo...
Given the criticism of GOG 88 and in light of various other recent data, would you deliver definitive XRT in place of inguinal lymph node dissection?
Despite GOG 88 findings, a number of retrospective studies have suggested that regional prophylactic RT is an effective method of preventing groin recurrences with minimal morbidity when appropriately delivered. (Combined across retrospective series, the incidence of groin recurrence following treat...
How does metaplastic thymoma histology impact your decision regarding adjuvant radiation?
This is a good question. I honestly have never seen this histology, and I help write the UpToDate thymoma section and am a thymoma enthusiast (meaning I like to read about it/treat it, not to have it). Thymomas really run the spectrum of aggressiveness, and the approach to them in the adjuvant setti...
How do you differentiate demoralization from depression during cancer treatment?
Certainly a key question in all referrals for "depression" in psycho-oncology. The two syndromes have areas of overlap and are not mutually exclusive. Clinical depression in cancer looks much like it would in any other context, though non-specific physical symptoms that can be caused by the cancer/t...
Would you offer SBRT for intraprostatic recurrence after definitive RT in a patient with contraindications to ablation and brachytherapy?
This is a very nice review on this topic, highlighting brachytherapy and SBRT for salvage after previous EBRT - A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER) - ScienceDirect.
Would you give immunotherapy after neoadjuvant gem-cis for bladder cancer if cystectomy is being postponed for months due to non-autoimmune/unrelated comorbidities?
Delay in cystectomy regardless of the use of neoadjuvant chemotherapy is associated with compromised survival outcomes (Chu et al., PMID 30840335) and if a patient receives neoadjuvant chemotherapy and is unable to undergo cystectomy for months due to comorbidities, there is no clear data to support...
What dose-fractionation do you use for salvage HDR brachytherapy for biopsy proven locally recurrent prostate cancer after prior external beam radiotherapy?
I believe most people use 27 Gy in 2 fractions (two insertions spaced by 1-2 weeks) based on a prospective, pilot study from Sunnybrook (NCT01583920; Corkum et al., PMID 35718075). Another dose schedule used by some is 32 Gy in 4 fractions (single insertion, > 4 hrs between fractions over 30 hours) ...
What is the optimal dose fractionation for treating liver metastases in the central liver causing obstruction of biliary flow?
This question is somewhat controversial, which is surprising to me. The standard ablative dose for ablation of liver mets is 100 Gy BED10. This results in local tumor control of 90% at 2 years for CRC liver mets, but drops off to 70% at 5 years. Other histologies may be more sensitive. The biliary t...
Is there a role for radiation in biphenotypic sinonasal sarcoma?
It’s a sarcoma, so there may be a role in the neoadjuvant or adjuvant setting. Not for definitive therapy, however. Surgery is the mainstay of definitive management of sarcoma. If there’s no surgical option then you can consider out-of-the-box approaches with SBRT or hypofractionation, or even brac...
Would use of proton radiation versus photon radiation in neuroblastoma patients post autologous stem cell transplant reduce the risk of transplant associated-TMA?
Transplant-Associated Thrombotic Microangiopathy arises partially due to injury to the endothelium; it is one of the “endothelial injury complications” of hematopoietic stem cell transplantation (HSCT), along with veno-occlusive disease (VOD) and engraftment syndrome (ES), among others. There is a w...