Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer SBRT for intraprostatic recurrence after definitive RT in a patient with contraindications to ablation and brachytherapy?
This is a very nice review on this topic, highlighting brachytherapy and SBRT for salvage after previous EBRT - A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER) - ScienceDirect.
Would you give immunotherapy after neoadjuvant gem-cis for bladder cancer if cystectomy is being postponed for months due to non-autoimmune/unrelated comorbidities?
Delay in cystectomy regardless of the use of neoadjuvant chemotherapy is associated with compromised survival outcomes (Chu et al., PMID 30840335) and if a patient receives neoadjuvant chemotherapy and is unable to undergo cystectomy for months due to comorbidities, there is no clear data to support...
What dose-fractionation do you use for salvage HDR brachytherapy for biopsy proven locally recurrent prostate cancer after prior external beam radiotherapy?
I believe most people use 27 Gy in 2 fractions (two insertions spaced by 1-2 weeks) based on a prospective, pilot study from Sunnybrook (NCT01583920; Corkum et al., PMID 35718075). Another dose schedule used by some is 32 Gy in 4 fractions (single insertion, > 4 hrs between fractions over 30 hours) ...
What is the optimal dose fractionation for treating liver metastases in the central liver causing obstruction of biliary flow?
This question is somewhat controversial, which is surprising to me. The standard ablative dose for ablation of liver mets is 100 Gy BED10. This results in local tumor control of 90% at 2 years for CRC liver mets, but drops off to 70% at 5 years. Other histologies may be more sensitive. The biliary t...
Is there a role for radiation in biphenotypic sinonasal sarcoma?
It’s a sarcoma, so there may be a role in the neoadjuvant or adjuvant setting. Not for definitive therapy, however. Surgery is the mainstay of definitive management of sarcoma. If there’s no surgical option then you can consider out-of-the-box approaches with SBRT or hypofractionation, or even brac...
Would use of proton radiation versus photon radiation in neuroblastoma patients post autologous stem cell transplant reduce the risk of transplant associated-TMA?
Transplant-Associated Thrombotic Microangiopathy arises partially due to injury to the endothelium; it is one of the “endothelial injury complications” of hematopoietic stem cell transplantation (HSCT), along with veno-occlusive disease (VOD) and engraftment syndrome (ES), among others. There is a w...
Would a metal endobronchial stent within the treatment field change your radiation treatment plan for a thoracic malignancy?
No, a stent placement within an airway would not alter either the appropriateness or the planning of radiotherapy for a thoracic tumor. That said, I would discuss the long-term implications of a stent in an irradiated field and would follow the patient closely with pulmonary medicine to discuss the ...
In patients with perihilar cholangiocarcinoma eligible for liver transplant, what is the protocol for neoadjuvant chemo-RT, particularly when brachytherapy is not available?
There is a lot of variability in neoadjuvant regimens prior to transplant for hilar cholangiocarcinoma as outlined in the survey paper above. Institutional approaches for total dose, fractionation, and target volumes vary considerably. A couple of points to consider and some personal opinions - Phil...
Would you ever consider SRS as a salvage option as an alternative to whole brain radiation for secondary CNS lymphoma?
The optimal management of secondary CNS lymphoma is not clear. Clinical considerations include the age and performance status of the patient, distribution of disease (CNS only versus systemic and CNS), prior treatment, etc. In most cases, high-dose methotrexate (HD MTX) based regimens are pursued. I...
Do you omit APBI for lobular histology?
If meets the other criteria, we do offer APBI. GEC estro and NSABP randomized trials did include lobular pathology.