Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you optimize patient set-up and planning for the post-operative treatment of a distal lower extremity sarcoma?
The fundamentals I take into consideration for every sarcoma patient I treat is:- Every sarcoma patient is very different but I try and keep my overriding paradigm very clear and consistent patient to patient so as to maximize my team's understanding of the patient's care and minimize risks of error...
How do you optimize nutrition for patients experiencing dysphagia while undergoing chemoradiation therapy for esophageal cancer?
Providing adequate nutrition for patients on treatment for esophageal cancer can be difficult. Evaluation and management should employ a multidisciplinary approach with individualized dietetic advice. In patients with the ability to swallow up-front, we start chemoradiation without employing other m...
Do you always biopsy suspicious liver lesions if you have a biopsy from the pancreatic mass showing PDAC?
I don’t always biopsy especially if the tumor marker is very high. I start with treatment and reassess. I do think a good liver MRI with contrast can be helpful here as well. One important caveat: I do biopsy if there is scant tissue from the pancreas biopsy so I can send the NGS panel.
Is there ever a role for adjuvant chemotherapy and/or immunotherapy for early stage, N0 non-small cell lung cancer treated with SBRT alone?
Excellent question. There is certainly a need! If we step back and take an honest look at our control rates with SBRT, while primary tumor control rates are high, we suffer the same viciousness of lung cancer that surgeons do - local control is trumped by a 2-3x rate of regional and distant failure....
Do you offer RNI to a T1N0 breast cancer patient who underwent inadequate axillary dissection?
I would not do RNI but include level 1 and 2 nodes for inadequate assessment of axilla with a tangential field for BCS.
Would you consider elective neck nodal irradiation for a large >5 cm head and neck extramedullary solitary plasmacytoma arising from the nasal cavity?
A plasmocytoma in the nasal cavity may bear a higher risk for nodal involvement if it involves Waldeyer's ring or nasopharynx.Adding ENI to the neck will certainly increase the risk of toxicity and only lead to a modest benefit in terms of isolated regional recurrence. I would thus not perform elect...
For SRS, do you prefer fixed kV imaging (e.g. ExacTrac) or cone-beam CT?
In our practice (at U Rochester), we have the ExacTrac system which captures orthogonal X-rays for each couch rotation, using 2 imaging sources on the floor and 2 imaging detectors on the ceiling (in a criss-cross orientation). So, you never get typical AP and lateral films (which I have become accu...
Do you hold palbociclib (or another CDK4/6 inhibitor) in a patient with metastatic HR+ breast cancer while receiving palliative radiation?
Currently there are no large studies on combining radiation therapy with palbociclib. Many of the patients with hormone receptor positive metastatic breast cancer have bony metastases and often need radiation for palliation. There is a small study showing that combination of radiation and palbocicli...
What is the optimal sequencing for SBRT boosts in prostate cancer?
I prefer to follow the schedule used on the PROMETHEUS trial (prospective, phase 2) and have had good results. Wegener et al., PMID 38302321 This protocol delivered an upfront 2-fraction SBRT boost with each fraction given 1 week apart. The EBRT component (46 Gy in 23 fractions) was then delivered 2...
In patients undergoing pre-operative chemoradiation for rectal adenocarcinoma with clinically positive pelvic sidewall nodes that may not be surgically accessible, do you boost these nodes above 50.4 Gy?
I use IMRT with a simultaneous integrated boost to 62.5Gy or 70Gy to lateral pelvic, non-TME nodes that are greater than 5 mm on MRI. I use 70Gy when I can spare the sciatic nerve and the ureter, otherwise 62.5Gy /25 fx (the low pelvis receives 50Gy). I always asked the surgeons if they plan to remo...