Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What's your follow-up protocol for a near complete response (nCR) in rectal patients considering non-operative management (NOM)?
This is a question that comes up in our colorectal tumor board routinely. For patients with a near-complete response after the completion of TNT, we recommend repeating an MRI of the rectum and endoscopic exam ~8 weeks later. If there is still a lack of complete response, our formal recommendation i...
How should radiation oncology departments prepare for significant resource depletion and/or staff shortages with the COVID-19 outbreak?
Resource depletion to the extreme would be analogous to having a non-operational clinic as some experienced during the Hurricane María disaster. I would suggest reading the paper:Lessons Learned From Hurricane Maria in Puerto Rico: Practical Measures to Mitigate the Impact of a Catastrophic Natural ...
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
Would you include a seroma in an adjuvant radiation field for post-op endometrial cancer?
The general principle I follow is if I can include it safely, I would. Otherwise, would skip most of it (lymphocele). If lymphocele is the site of positive pathological node, then include it in CTV.
Is it necessary to include entire lymphocele in CTV while treating post operative nodal sites of pelvic malignancy?
I don’t know if necessary or not but I tend to include it if can do it safely. If large and pathological node was negative, then skip to reduce dose to OAR.
Are the results of CONKO-007 changing practice for the management of pancreatic cancer?
The results of CONKO-007 are exactly as expected. The clinically relevant endpoint of OS was not improved with the addition of chemotherapy. These results are similar to the PREOPANC-2 trial in BRPC. Since definitions are rarely followed in practice, BRPC and LAPC populations have merged over time; ...
What measures should we take regarding routine follow-up visits for well patients in surveillance during the coronavirus pandemic?
3-6 months.
What is the best approach to treat a triple-negative inflammatory breast cancer with pCR following preoperative chemotherapy and a prior history of ipsilateral breast irradiation?
Given inflammatory breast cancer recurrence, even with history of previous breast RT, I would offer reirradiation. Given DCIS, nodal irradiation would not have been used and the breast would be removed at mastectomy leaving chest wall. I would give dose of 50 Gy to CW and nodes, and I would use some...
For ultracentral lung cancer abutting the heart, what dose constraints would you use for the heart and bronchus if using 10 fraction ultrahypofractionation?
The dose deviation from Timmerman for the heart is 60 Gy in 10 fractions. Now that they are published, I'd utilize the SUNSET constraints. Patients received 60 Gy/8 fractions (rather than the 10 fraction regimens questioned here) but the best data we have to extrapolate and use constraints that are ...
Have you seen an increase in rectal spasms with short course vs long course radiation for rectal cancer?
The side effect profile is very different with 25/5 RT vs long course CRT. There is no question that 25/5 is “easier” to finish, because the side effects almost invariably start after the last fraction. The acute toxicity of 25/5 is after treatment and, as mentioned above, includes spasm, sensation ...