Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can we use a linear accelerator to sterilize PPE?
Per FAQ's posted by ASTRO: "At this time, ASTRO does not recommend the use of clinical linear accelerators to sterilize PPE. While ionizing radiation is used for sterilization of blood and food products, this is achieved using industrial irradiators that use gamma irradiation at doses rates far grea...
Should we be stopping new starts of patients who can be triaged for 2-3 months like prostate cancers on ADT when significant community spread of COVID-19 is detectable in our area?
I would for those patients requiring ADT, which is the way I interpreted the question. I want to elaborate more because @Dr. First Last brought up other scenarios we should consider and he brings some more good points: Many patients could get active surveillance for a period of time before ADT is co...
How do you sequence radiation and capecitabine in breast cancer patients receiving adjuvant capecitabine for residual disease after neoadjuvant chemotherapy?
According to personal communication with Dr. Masakazu Toi (June 13, 2017), the corresponding author of the CREATE-X NEJM publication, radiotherapy was administered prior to capecitabine in the majority of cases on this study. It is worth noting that in CALGB 49907, a randomized trial comparing capec...
How long can you delay the start of radiation in a patient who has received adjuvant chemotherapy after lumpectomy/mastectomy?
I generally start radiation between 3 and 8 weeks following the last dose of chemotherapy. Since most protocol guidelines specify radiation should start within 12 weeks of the last day of chemo is within the last surgical procedure, I use that as an outside window I am comfortable with for the most ...
Would you give PMRT for a radiation-induced G3 pleomorphic sarcoma measuring 5.4cm with closest margin to skin of 0.1cm, in the context of reconstruction and a VUS in TP53?
This is a really tough case, and I would be interested to hear what other sarcoma colleagues would do. Personally, I would not routinely recommend postoperative RT in this setting, but I would want more information before making a final recommendation. The high grade, 5.4-cm tumor and very close (1m...
What are best practices for radiation oncology patient and staff precautions with the COVID-19 pandemic?
COVID Update 1/30/21 Wow, it's been almost a year. Here are some updates from our practices at University of Maryland. We have successfully treated both PUIs and COVID+ patients at all of our practices. We have yet to have a patient to staff (or staff to patient) transmission. We do not break patien...
What is your treatment paradigm for rectal cancer in the setting of COVID-19?
We haven't changed our standard recommendation: short course radiation -> 3-4 months of FOLFOX. In a very timely manner, the RAPIDO ASCO abstract was released here in May. It showed that the patients who received short course radiation -> FOLFOX had improved pCR, less disease related treatment failu...
For locally advanced breast cancer, to what dose do you treat undissected clinically positive level III axilla, SCV or IM nodes?
At MD Anderson Cancer Center, we systematically stage the regional nodes using ultrasound. We biopsy suspicious nodes with FNA at the time of ultrasound. Given this systematic approach to staging, we have a large experience treating patients with biopsy-confirmed infraclavicular, supraclavicular, an...
Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?
This is an important question where the evidence is evolving, and some key trials remain ongoing. Because the data remains in flux, in the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- prophylactic cranial irradiation (PCI) for LS and ES-SCLC, where I serve as the PI, hippocampal...
How does your institution approach the management of node positive bladder cancer?
We typically treat with neoadjuvant EV/pembro, and if there is no progression, deliver pelvic chemoRT. We don’t treat N1-3 differently from each other and generally use this approach.We use the ECOG/NRG 8185 approach for RT planning, although the trial closed early due to poor accrual.Our group has ...