Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach boosting a vaginal cuff recurrence of cervical cancer with brachytherapy that is tethered to small bowel?
Tough case. Controlling cancer is important. MRI guided brachy and making sure GTV is adequately covered even if bowel wall gets that dose. Warn the patient about bowel obstruction and the need to bypass in future.
Would you ever offer a simultaneous integrated boost to the lumpectomy cavity with 5 fraction ultra-hypofractionated whole breast radiotherapy (2600 cGy in 5 fractions)?
Yes, it was delivered in the trial although with conventional fractionation. In practice, we do 2.5 x 4 or 5.2 x 1-2 fractions like RCR guidelines.
How do you approach a patient with a radiographically proven recurrence in the prostate bed after prostatectomy?
We have been getting earlier referrals for salvage RT, so these types of cases have become less common for us to see. We would probably offer RT assuming there is no evidence of distant disease (we have begun using fluciclovine PETs selectively to see if it help with patient selection or alters trea...
For recurrent prostate cancer after prostatectomy with soft tissue mass in the prostate fossa, is hypofractionation an option or is standard fractionation recommended?
There is no standard, accepted modification of a treatment plan for the detection of gross residual/recurrent disease in the operative bed; however, a few common approaches have been reported. These options, as they pertain to hypofractionated treatment regimens are discussed below. Treatment of th...
For a young female (<40) with HR-/HER2+ cT1-2N1, ypT1aN0 s/p mastectomy with SLNB, would you offer PMRT?
Thanks for the question. In the seminal PMRT randomized trials of patients treated with adjuvant systemic therapy, PMRT improved overall survival. B-51 was not designed to evaluate the non-inferiority of PMRT omission. Beyond being less conservatively designed to test for superiority of "RNI" with r...
Will you offer patients urea-based creams or topical diclofenac for hand-foot prophylaxis with capecitabine after the D-TORCH trial results?
This study was presented at ASCO, Abstract 12005. Patients with breast or GI cancers treated with single agent capecitabine (1,000 mg/m2 bid) were randomized to treatment with prophylactic diclofenac cream bid x 12 weeks vs placebo. Primary endpoint was incidence of grade 2 or greater HFS. HR for th...
In light of the improved outcomes seen in patients receiving IO +/- olaparib, what role, if any, do you think pelvic radiation still plays in the management of patients with advanced endometrial cancer?
The study included a wide spectrum of patients including advance stage with residual disease or recurrent with or without residual disease. Prior RT when indicated was allowed and about 40% had RT as part of care.
Will you offer single fraction SBRT for pulmonary oligometastases?
We use single fraction radiation frequently for most peripheral lung metastasis. In addition to TROG 13.01/SAFRON-II (randomized to 48 Gy/4 fx versus 28 Gy/1 fx, with the important footnote that dose was prescribed for 99% PTV coverage rather than the typical 95%), two other randomized trials - RTOG...
What brainstem constraints do you use when giving single fraction SRS for trigeminal neuralgia vs brain metastases?
Dose prescription for brain metastases is dependent on volume, location, and prior radiation exposure. With lesions in the brain stem we decrease the dose compared to the standard doses we deliver. For small volume lesions (< 1 cm3) we generally use margin doses of 20 Gy, with lower doses for larger...
What is the maximum interval you would consider delivering adjuvant radiation therapy for endometrial cancer?
The data has not been evaluated prospectively but retrospective studies suggest RT delay beyond 8-9 weeks after surgery decreases efficacy of treatment. That being said, have treated high risk patients up until 16 weeks but explained the pros and cons of treatment.https://www.ncbi.nlm.nih.gov/pubmed...