Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For an early stage, estrogen receptor positive breast cancer in an elderly patient, would you recommend: hormonal therapy alone, radiation alone or both?
Based on the CALGB (and PRIME II, shorter follow up) data hormonal therapy without RT is a reasonable choice for many older patients given that there is no survival advantage to the addition of RT. Some patients who are in excellent health and want the maximum risk reduction, may be candidates for a...
Would you recommend observation for an early stage, low grade, ER+, pure tubular carcinoma of the breast after lumpectomy with negative margins for women younger than 65?
We have data in this subset of patients from BASO II. Essentially, the risk of 10-yr LRR was ~20% with nothing, 8% with endocrine tx or RT, and 2% with both. When I treat these patients, I give 40.05 Gy no boost. External beam APBI like IMPORT LOW seems quite reasonable. I would happily enroll these...
Are there extra precautions required for SBRT to a lesion that is proximal to an aortic aneurysm?
Instead of jumping to the SBRT issue, I would like to take the question as posed because I think there is a question of clinical appropriateness involved. If I were referred a patient with an aneurysm at high risk of rupture and who has a concurrent early stage lung cancer for which SBRT was being r...
Do you offer adjuvant durvalumab for stage I small cell lung cancer following SBRT or surgery?
Obviously, there are no direct data, and the standard is EP chemotherapy. The cure rate in this situation is still suboptimal, but the majority of patients are cured. Adding IO might improve survival, but will most certainly increase cost and toxicity. I would discuss with patients, and I often tell...
What is your general approach to treating bleeding gastric masses with palliative RT?
We once had a patient with stage IV NHL who had transfusion-dependent bleeding from a pesky gastric mass that was chemo-resistant. It turned into a fatal complication, so it was presented as an educational case at ASTRO. We gave 4 Gy x 1 which stopped the bleeding within 24h, and switched to 3 Gy x ...
In what situations do you routinely use posterior axillary boost (PAB) for breast cancer radiotherapy?
The concept of the "PAB" is like the zombie that claws out of the ground every now and then (usually to haunt a resident who is getting ready to take the oral boards and is trying to memorize [cough!--irrelevant] bony landmark setup fields). Breast cancer radiotherapy is really idiosyncratic among s...
When do you recommend SRT, if ever, for small SCCs and BCCs?
SRT is a highly effective treatment for superficial radiation therapy. What is alarming is the use of daily US guidance for something we can visualize with our eyes. With electrons, I’ve never heard of anyone using image guidance. With SRT, the request for daily image guidance is routinely requested...
What is the significance of PNI in cutaneous BCC?
Little data out there (unlike PNI in SCCa); if the surgical margin is adequate and a local recurrence for re-excision would be devastating, I'd observe. If a local recurrence would result in a very poor cosmetic outcome after re-excision, I'd offer RT (50 Gy involved site).
Would having mucinous rectal adenocarcinoma impact your recommendation for short vs long course RT as part of a TNT regimen?
I would have no problem treating this case with five fractions of 5 Gy, followed ~2 weeks later with total neoadjuvant chemotherapy, followed by extirpative surgery; with the RT/surgical template similar to that of the investigational arm of the RAPIDO study (Bahadoer et al., PMID 33301740). Note t...
Should BED or EQD2 be used when deciding on a fractionation scheme for breast cancer radiation, and should tumor or normal tissue be prioritized in this consideration?
I feel, with many prospective randomized data, we are beyond looking at EQ2 dose for deciding fractionation. We follow the below rationale/pathway in our practice. Is biology suitable for PBI or not? (If suitable then plan for 30 Gy in 5 fractions like Italian data) Biology is suitable for PBI but ...