Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer APBI to a patient with very large breast anatomy and a small lumpectomy cavity after an oncoplastic closure?
I would offer it with the caveat I always offer APBI candidates which is that final suitability will be determined at sim to ensure the surgical bed is evident and suitable for APBI. The breast surgeon will mark the tumor bed with clips and if the closure hasn't disrupted or dispersed the clips, APB...
What is the optimal management of pain and loss of function due to pathologic compression fractures?
I explain to my patients if they have an acute compression fracture that they are likely to experience pain for approximately 2-3 weeks that will gradually resolve. I often give them some type of pain relief using Tylenol or ibuprofen and if severe, a more potent analgesic for a short period of time...
Would you offer ultra-hypofractionated accelerated partial breast re-irradiation using 5 fractions?
I have favored 40 in 15 or 45 in 30 for now in view of reradiation
Would you recommend radiotherapy to upper-tract urothelial carcinoma in an inoperable patient?
Unfortunately, there are no good data to guide a decision in this circumstance. Assuming that this is a patient with a small tumor localized to the upper tract with no evidence of nodal or distant disease, radiotherapy might be a reasonable option to either palliate symptoms due to obstruction or bl...
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....