Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the best way to treat a small brainstem met with stereotactic radiosurgery?
Small brain metastases in the brainstem can be treated with radiosurgery safely. Typically, the dose is dialed down to minimize the risk of radiation necrosis within the brainstem. At our institution, we typically reduce the dose down by one dose level using the RTOG scheme. For example, a 2 cm or l...
Has use of PSMA PETCT revealed increased local failures than previously known after definitive prostate EBRT with biochemical failure?
Prior to the advent of PET imaging, the published rates of local recurrence (LR) after definitive RT vary widely in phase III trials from ≈ 1% (e.g., PCS IV) to ≈ 30% (e.g., PROG 9509). The heterogeneity is likely explained by several factors including (1) differences in baseline risk of local recur...
How would you approach an intrathoracic solitary fibrous tumor in a patient who is not a surgical candidate?
Unresected SFT can have good outcomes with definitive-intent RT: Haas et al., 29859795. SBRT or hypofractionated regimens seem reasonable if the location allows. If not, conventional fractionation to 60-66 Gy.
What criteria do you use to decide between 1 fraction vs multi-fraction (e.g. 5 fractions) for WHO 1 meningiomas?
This is an important, frequently encountered, and clinically relevant question. I will address it as posed, but intend to emphasize that, although stereotactic radiosurgery (SRS) is an important therapeutic option for WHO grade I meningioma patients requiring RT, it does not displace external beam R...
Is it reasonable to extrapolate the findings of RT Charm and Alliance to intact breast patients and offer hypofractionated RNI to all patients who are eligible for RNI?
Yes. I wouldn't see any reason it would be an issue. We know hypofractionation for intact breast is fine. There are no issues with RNI and hypofractionation. So, there should be no issue in combining.
What is appropriate followup duration after treatment for an acoustic neuroma?
Annual follow up is appropriate for most patients, and q6m MRI may not be necessary. If possible, long term follow up of 10 year or longer is prefered. The local control of acoustic neuroma with radiation treatment (SRS or FSRT) is excellent. Most series reported long term control of 95% or higher....
What are your top takeaways in Neuro Oncology from ASTRO 2024?
A Prospective, Phase II study of 177Lu-Dotatate in patients with surgery- and radiation-refractory meningioma: Results of the WHO grade II/III cohort, presented by Kenneth Merrell. I have spent a large portion of my career emphasizing optimal management for meningioma patients and this study opens ...
How do you approach deciding between SRS and fractionated radiation for an acoustic neuroma?
Offer fractionated RT if patient has serviceable hearing (can use the phone on that side). Otherwise SRS if less than 3 cm. If larger than 3 cm and not a surgical candidate, fractionated RT.
What is your approach to managing follicular lymphoma with central nervous system involvement?
Not really an expert on this issue. Fairly uncommon to have a follicular lymphoma-associated CNS disease. Our usual is for high-dose methotrexate, Temodar, and rituximab. Potentially followed by autologous stem cell transplant.
Would presence of DIEP flap reconstruction impact your decision to proceed with a BID approach to PMRT for inflammatory breast cancer?
The short answer is no. I would first carefully review the history that led to an IBC patient having immediate reconstruction since immediate reconstruction is not recommended and it warrants a careful review. Ideally, the patient would have upfront photos of skin involvement, bilateral nodal evalua...