Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
What factors do you consider when selecting dose/fractionation for whole brain radiotherapy?
I assume this question is for brain metastases patients who are not eligible for hippocampal avoidance WBRT (ineligible criteria including but not limited to - mets 5 mm within either hippocampus, germ cell/small cell/lymphoma, leptomeningeal disease, etc.) - my default WBRT dose fractionation is 30...
Would you offer hippocampal sparing whole brain radiation for patients with brain metastases due to ES-SCLC?
Until we have built-in auto-segmentation, I find the RTOG contouring atlas very helpful for manual contouring of the hippocampus. I tend to use the lateral ventricle as my main landmark, and look for the circle of gray matter located medial to it. Once I've drawn a hippocampus, I'll look at it in th...
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...
Are CHEK2 mutations a contraindication for breast conservation therapy with lumpectomy + RT?
Among women with early-stage breast cancer and moderate penetrance breast cancer susceptibility genes, such as CHEK2, decisions about breast surgery are largely based upon personal preferences. According to data from large population-based studies, women with CHEK2 pathogenic variants have about a 2...
Do you constrain the dose to the oropharynx, parotids, or oral cavity when planning HA-WBRT?
On NRG CC001, there was no inter-arm difference in reported adverse events of oral mucositis (N=6 on conventional WBRT arm vs. N=4 on HA-WBRT arm), oral pain (N=3 on conventional WBRT arm vs. N=1 on HA-WBRT arm ), or dry mouth (N=19 on conventional WBRT arm vs. N=18 on HA-WBRT arm) (Brown et al., PM...
Are there any trials currently studying low-dose RT for confirmed COVID-19 infections with associated pneumonia?
This is a joint reply from a team developing a prospective trial to answer this question:Minesh Mehta, Arnab Chakravarti, Walter Curran Jr, James Fontanesi, Vinai Gondi, Michael Kasper, Deepak Khuntia, Rupesh Kotecha, Ramesh Rengan, Leland Rogers, Charles B. Simone II, James Welsh, George WilsonThis...
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...
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...
Would you omit RNI in a patient with locally advanced TNBC with N1 disease who has an ALND and is found to have a pCR in the nodes?
This is the topic of the NRG B-51 randomized clinical trial which recently closed to new patient accrual. Until we have data from this trial, my default will be to prefer RNI in my triple negative patients known to have nodal involvement at the time of diagnosis, even if they experience a nodal pCR....