Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What clinical and pathologic features do you use to discern whether >= 2 synchronous lung nodules, biopsy proven lung adenocarcinoma, are different primaries versus metastatic disease?
These cases are always discussed at a multi-disciplinary tumor board with a review of pathology slides from the operative specimen. In some cases, there are clearly different morphologies or levels of differentiation. These can be initial clues, but not definitive to determine synchronous primaries ...
Do you recommend holding a KRAS inhibitor during palliative radiotherapy?
I have no personal experience or anecdotes and know of no current data or literature that would address this very specific question and this may be due to the limited experience on the potential interaction of this class of drugs and radiotherapy, since this drug is relatively new.This class of drug...
What are your top takeaways in Thoracic Cancers from ASCO 2022?
1. Abst 8502 - Quality metrics and survival after lung cancer surgery: More efficient work-ups and consistently high quality resections will likely do more to improve lung cancer survival than any adjuvant or neo-adjuvant therapy we can come up with. This is low-hanging, low-cost fruit. 2. Abst 9007...
What are your top takeaways in Thoracic Cancers from ASCO 2023?
Always so hard to pick a top 3 as luckily each ASCO provides us with a broad spectrum of significant advances in our field but if pressed against the wall, I might pick below 3: The first is a double dip choice I admit matching ADAURA with KN789. Of course, you need to be living in a cave not to be ...
Would you offer re-irradiation for recurrent vaginal bleeding?
Based on the previous dose, there is an opportunity for more doses for palliation. Dose and fractionation would be driven by KPS and expected survival. I have done quad shot, 30 in 12 to brachy in these situations based on the above.
Would you recommend post lumpectomy RT in an elderly woman with a T1N0M0 stage breast cancer ER/PR/HER2 positive?
As your question states, neither CALGB 9343 nor the PRIME II study assessed HER2 status of its patients as both of these trials commenced prior to the routine testing of HER2 status. So we cannot glean any information from these randomized trials of the omission of radiation in the ER+ HER2+ patient...
Is it safe to offer SBRT for a secondary NSCLC after breast or chest wall irradiation many years prior?
I agree with @Dr. First Last. Surgery is preferred here. However, if surgery is not an option or is high risk, I would offer SBRT. I still offer 10 Gy x 5 in this setting because if I do it, I still want to offer the best chance for tumor control (10 Gy x 5 has a BED10 = 100 Gy, the threshold dose)....
Would you consider moderate hypofractionation for men with large prostate (>100cc) and poor AUA/IPSS score?
Size of the prostate, per se, is not a contraindication to moderate hypofractionation, if you can meet your dose constraints. However, I am much more concerned about a poor AUA/IPSS score when recommending radiation. I prefer conventional fractionation EBRT in these patients. In my experience, their...
For treatments using thermoplastic mask immobilaztion, when supplemental bolus is needed, what is your method for ensuring reproducibility of set-up and bolus effect efficacy?
In most cases, my bias is to place under the mask, so that I am more confident that bolus is flush against the skin and there is less room for airgap in the event of anatomic change / weight loss. For areas of bony prominence (scalp, cheek, etc.) in cases where weight loss is not expected, placement...
How has advanced imaging, especially PET/CT, changed your treatment volumes and approach for a head and neck cancer of unknown primary?
PET may identify contralateral positive nodes that were negative or borderline on CT and distant Mets not appreciated on chest CT. These account for a small proportion of patients. The false positive rate in the oropharynx is about 35% so not much help there. So, in general, no.