Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach an isolated supraclavicular nodal recurrence involving the skin in a patient who has received standard chest wall and nodal radiation therapy?
Very challenging situation. Assuming it has been a few years out from the standard RT, and that the nodal mass is in relatively close proximity to the brachial plexus (as it cannot be too far), I would consider: Repeat external beam RT, hyperfractionated to increase the therapeutic ratio (i.e., redu...
How can I maximize my efficiency in the clinic?
I have found that my time is better spent if I: 1. Get in an ~hour before official work schedule time period. 2. See all my OTVs on Mondays (or Tuesdays for holidays). I found that seeing them on Thursday or Fridays allows for more visits on the following Monday because of weekend issues. No simulat...
How would you approach unexpected chemo breaks during planned neoadjuvant chemoradiation for esophageal adenocarcinoma?
Local regional failure compromises quality of life
Does low Decipher score alter your duration of ADT for a high risk prostate cancer patient?
This question contains a few very important concepts that I think most of us were not trained to appreciate (I wasn't) that I will try to expand on: What truly is an NCCN risk group and what is its importance? How to incorporate more accurate prognostic biomarkers? While it may sound odd to some to...
Do you treat pre- or post-chemotherapy nodal volumes on a patient with NSCLC following induction chemotherapy?
After induction chemotherapy, I treat all initially involved nodal stations to a definitive dose. If there is improvement in the parenchymal disease, I consider reducing my volumes to the post-chemo target, though I do so cautiously and often encompass that region with the CTV as well.
Is there any situation where hypofractionation of post-mastectomy radiation (CW and regional nodes) is absolutely contraindicated?
While not absolute given some phase 2 data, I am not currently offering hypofractionated PMRT to patients with reconstruction, as I am awaiting results of the Alliance trial. I do offer hypofractionated PMRT to patients who are not undergoing reconstruction. However, I am cautious in patients with c...
How do you determine your treatment volumes when treating with chemoradiation for bladder cancer?
Good question! The fields for bladder preservation with chemoradiation have not been standardized, and there are multiple reasonable options based on trials/experiences for certain fields. In general, it is important to try to minimize dose of RT to adjacent tissues that are more sensitive. Because ...
How do you approach repeat SBRT in the abdomen, specifically when considering constraints for bowel and mesenteric vessels?
Great question with no clear guidelines. If it was the same lesion of prior RT, I would consider other liver-directed therapies as I would worry about the ability to get in meaningful dose. If it was a different lesion, I would create a cumulative plan and try to minimize bowel dose aggressively. If...
Do you ever use VMAT for breast cancer?
We do use it for RNI if can’t meet OAR constraints or when doing SIB boost. Aim for V 20 < 25% for ipsilateral lung and mean heart dose of <2-3 Gy depending on the importance of covering IMN.Certainly, coverage and conformity are better with VMAT. Low dose volume is larger with VMAT but prescription...
How do you approach a patient with undifferentiated pleomorphic sarcoma encasing the spinal cord post radiation for neurological deficits for further management?
We will need some more information here. Did the patient present with cord compression? What level of cord is involved? Is the tumor causing functional issues in the patient (paralysis, bladder issues, etc.)? What was the dose of radiation used? Was this definitive RT or palliative RT? Is there any ...