Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways in Medical Oncology from SABCS 2025?
lidERA trial. This is the first phase III trial showing an advantage for an oral SERD giredestrant over standard endocrine adjuvant therapy in early breast cancer. Treatment with giredestrant led to a 30% reduction in the risk of invasive disease recurrence over standard endocrine therapy at the fir...
How will the LORETTA and COMET trials influence your treatment of low-risk DCIS?
Clearly, postop RT can be avoided, but the pink elephant in the room is, can 5 years of endocrine therapy likewise be avoided? Treatment de-intensification requires addressing all aspects of therapy, particularly if one argues against adjuvant therapies for reasons of cost and toxicity. I can't reca...
When would you offer single fraction adjuvant partial breast irradiation instead of a 5-10 fraction course for early stage breast cancer?
We have not offered a single fraction, and our standard is 26 to 30 in 5 fractions. Data on a single fraction is not enough to support this recommendation for now.
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...
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...
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...
In the era of NSABP B51, how do you approach patients with occult primary who achieve a pCR in the nodes?
One can go either way, but would look at pre-chemo phenotype, nodal size, nodal number and location, and if any one of them favors RNI along with breast RT.
How do you check surface dose when treating post-mastectomy patients with radiation?
We have stopped using bolus except for T4b disease, dermal involvement, or extensive LVSI, pathologic dermal involvement, or positive margins. In cases where we use bolus check with in vivo dosimetry and aim for 90% or above dose. Another situation where a bolus may be used is in a very thin chest w...
How would you empirically manage a large sellar/suprasellar mass with encasement of the right cavernous and terminal internal carotid arteries?
Knowing the histology of the mass would really help in creating more accurate treatment recommendations. A biopsy of a sellar mass is usually accomplished by an endonasal-endoscopic transsphenoidal approach utilizing the expertise of an ENT surgeon and a skull-base neurosurgeon. However, in this cas...
Should hippocampal-avoidance WBRT be the default option for WBRT?
I think this is a difficult question to answer as a lot depends on the particulars. Here's a list of some of those issues: Radiosurgery is very easily administered & frequently free of toxicity. Systemic agents are showing improved efficacy in the brain. Surveillance MR imaging = lower incidence of ...