Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What, if any, cardioprotective measures beyond dexrazoxane may be used to minimize cardiac risk during or after chemo- or radio-therapy?
For cardioprotection, I would recommend: Baseline cardiovascular risk stratification, can use the HFA-ICOS risk calculator (https://www.cancercalc.com/hfa-icos_cardio_oncology_risk_assessment.php), consider alternative chemotherapies if very high risk and alternative therapy equal efficacy. Optimiz...
Would you treat the pelvis electively while treating the prostate in a setting of low volume metastatic prostate cancer?
I think it depends on how low volume the metastatic disease is, and how it was detected. A tiny bone met that was only detected through a PSMA scan in a patient with otherwise negative conventional imaging would likely be different than someone with 5-10 bone mets discovered on a bone scan. We've li...
What is your approach to a tumor bed boost in early stage breast cancer patients with micrometastasis?
Micrometastases are not specifically associated with increased IBTR. I would use whatever algorithm you typically use to determine whether or not you boost.
When doing a tumor bed boost following whole breast irradiation, what do you typically use for CTV and PTV margin for photon and electron plans?
This is one of the few times that I do not do a traditional CTV/PTV expansion. "Old school" was a block margin of 2 cm around the scar - and then boost to a selected depth + choose IDL for coverage ("90% at 2 cm depth). We do know now that we risk missing the cavity if we rely on the scar, as we are...
Are weekly port films or daily cone beams considered standard of care for 3D breast treatment?
It doesn't have to be either/or. But...As Don Rumsfeld said, "You go to war with the army you have, not the army you want." Some practices, and they are rare admittedly (think: a site with only a Tomotherapy machine) can't really do "port films" per se and they're wont to do daily IGRT/CBCT. If "MRI...
How would you treat a basal cell carcinoma on the temporal skin and zygomatic area s/p excision with PNI and significant flaps for closure?
This case is a challenge as it is not clear what the indication for PORT is. Margin status is important, so discuss with the surgeon, and if positive, can a repeat resection occur, likely not given the presence of the flaps, however. The guidelines from 2019 are a neat and logical review that establ...
For esophageal cancer treated with primary chemoradiotherapy, with residual disease on 3 months PET, would you repeat a PET at 6 months?
It depends on what the doc and the patient will do with the information. If the patient received primary chemo rads because they were not a surgical candidate initially, they would not be a surgical candidate after treatment. Thus, if there is a recurrence, any subsequent treatment would be palliati...
What are your top takeaways from SGO 2024?
SGO 2024 was a great meeting with many excellent presentations. We are truly “moving the needle together”. The following presentations are each practice changing. Duska et al., PMID 38521086: Pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer: randomized, double-bli...
Would you offer lung SBRT for an individual with rheumatoid arthritis?
I wouldn't hesitate to use SBRT in this setting, all things being equal. The important caveats for "equal" are whether they have any component of interstitial lung disease. I'm very fortunate to have access to proton therapy, and about the only time I use it for SBRT lung is in patients with severe ...
Is chronic methotrexate for rheumatoid arthritis a contraindication for prostate brachytherapy?
I would agree with Dr Rogers that there is really limited information with in the published literature to guide us in this specific clinical situation. In my personal experience I have recommended holding the methotrexate (if possible) prior to a planned course of external beam radiotherapy, HDR bra...