Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For brain metastases, what is the optimal time interval between surgery and post-operative SRS?
There is no clear consensus on the optimal time interval between surgery and post-operative SRS. In practice, several factors would play a role in the timing of post-operative SRS. Notably, I would say rather than post-operative SRS, I would argue whether my intent is adjuvant SRS or salvage SRS, me...
Do you recommend homogenous or inhomogenous dose distribution for postoperative SRS/FSRT for a resected brain metastasis?
For most intracranial and all malignant targets, homogeneous planning leads to poorer dosimetry and bad radiosurgery. Just don't do it. If you value conformity and gradient as plan quality metrics, you should not penalize heterogeneity within your target. For inversely planned SRS, the act of merely...
Would you offer post-operative SRS/SBRT in the case of a resected brain metastasis from metastatic NSCLC with an EGFR mutation?
Absolutely. For symptomatic brain metastases, I would not rely on the efficacy of systemic therapy alone either in the intact or post-operative setting. CNS objective response rates are around 60% for osimertinib with DCR around 90% which is quite good. However, intracranial complete response rates ...
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
This is an excellent question.Our group has been involved with amyloid/radiation effects in patients with Alzheimer’s disease Turn our initial run-up and through our most recent reviews, I have not seen any significant publications nor have I seen clinical situations that this addresses, although am...
How are you incorporating 68-Ga Dotatate PET scans in the management of grade I/II meningiomas?
Thank you for posing such a leading-edge question. I surmise its answer may have a rather different din a few years from now. However, to date, I am not using DOTATATE PET for meningioma. This is due partly to habit, availability, insurance constraints, and the specific clinical circumstances of the...
How do you manage an adult primary rhabdomyosarcoma of the lung/mediastinum?
COG trials include all patients <50 years old. The 5-year OS of patients treated in the most recent COG trials is over 70%. So, I would recommend you treat the adult patients per COG protocols if you do not enroll your patients in the COG trials. To manage rhabdomyosarcoma, we need to know the risk ...
How do you treat localized esophageal carcinoma in patients who are unwilling or unable to undergo chemotherapy or surgery?
This is a question that comes up occasionally in clinic. My viewpoint is generally based on the prospective data that we have. Of course, the RTOG 85-01 study showed 0% long-term OS with definitive RT vs CRT. Additionally, the Intergroup 0123 study showed no evidence of improvement with higher dose...
Do you leave the tracheostomy tube in place or take it out during each head and neck cancer radiation treatment?
I leave it in and don't bolus. I take it that we are referring to post total laryngectomy. If not, the patient should have had one. If so, bolus is likely unnecessary because the mechanism of a stomal recurrence is likely a level 6 node. Cheers!
When is the coverage of tracheostomy site required for Head & Neck cancer radiation therapy and to what dose?
I always take the stoma to 54-60 Gy, and boost to 66 Gy in case of any of the following: emergent trach placement subglottic extension anterior soft tissue involvement (i.e., through-and-through thyroid cartilage involvement and/or actual soft tissue involvement anterior to thyroid cartilage) conta...
When do you consider boosting the the tracheostomy site in post operative head and neck cancer patients?
I was taught that the stoma was included and treated to a subclinical dose (50 gy at 2 gy) in essentially all cases when post laryngectomy radiation was performed. The classic indications were detailed in the Fletcher texts, and a relatively old paper from MDA by Yuen et al. These include: extensive...