Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose/fractionation would you recommend for a prostate patient who previously received 1 of 5 planned fractions SBRT in 2020?
Tough case and a reminder of all the continuing fallout from the pandemic. My TL;DR is it's fine to deliver full dose and basically ignore the prior RT delivering as conformal and safe a plan as you can this time around. A couple more wordy thoughts:1. What's the benefit?For a man with very high-ris...
How do you approach the discussion and decision-making regarding surgery vs SBRT for stage I NSCLC in patients who are candidates for both?
I agree with Dr. @Dr. First Last that it requires a very nuanced and personalized discussion. Our Yale approach (led by Frank Detterbeck) has been detailed in a 4-paper series in the Journal of Thoracic Disease 2022 (overview and SBRT/ablation focus), with the general paradigm balancing short-term, ...
What chest wall boost volume do you use for patients with inflammatory breast cancer?
I will typically boost the scar + 2-2.5 cm. It's also important to make sure the scar boost volume was all included in initial tangential volumes.
Would you offer partial breast radiation to a young breast cancer patient with BRCA 1 if all other criteria are met?
I would favor whole breast RT as the incidence of recurrence/new primary is high and there is data to suggest RT to whole breast reduces that incidence Evron et al., PMID 30475942
How do you approach elective cranial nerve target volumes for head and neck cancers to account for potential retrograde or anterograde spread along cranial nerves?
In general, I’m electively covering cranial nerve branches in the setting of an advanced skin cancer with at least microPNI, an adenoid cystic carcinoma, an advanced paranasal sinus tumor with micro or clinical PNI or a nasopharyngeal carcinoma with clinical PNI. Occasionally there’s an advanced gin...
How would you recommend treating locally recurrent pancreatic cancer?
Referrals for these patients have been increasing over the last few years, most likely with the advent of more effective systemic therapy (or perhaps with the decrease of adjuvant radiation). I have not found much data to cite for these patients; but I have recommended stability/non-metastatic over ...
Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?
Yes, if the patients meet the rigid requirements for response, which include a rapid early response (Complete response or very good partial response) after 2 cycles of ABVE-PC chemotherapy AND have a complete response at the end of treatment then the data suggests similar outcomes whether or not the...
Can you re-treat vertebral metastases with SBRT?
I typically utilize the same prescription doses in the upfront and re-irradiation setting. The difference is typically in my cord constraint (and in effect the coverage of the target). In regards to the spinal cord constraint, I typically allow a cumulative BED3 of 70-75 Gy to the cord plus 2 mm acc...
In what clinical situations do you order NavDx?
At MSKCC, we largely use NavDx as part of our post-operative de-escalation trial in which NavDx is checked pre and post surgery to help select patients for de-escalation. If NavDx becomes undetectable after surgery: In patients with pathologic risk factors that warrant adjuvant RT, patients undergo...
How would you manage a POLE mutated, p53 abnormal IA myoinvasive carcinosarcoma of the endometrium with no LVSI?
I would not change the management of IB and above non-endometrioid histology based on mutation analysis as almost all data is for endometrioid histology.