Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat the whole bladder with a cervical cancer that is invading the bladder?
The short answer is no. The posterior wall of the bladder is generally what will be involved and will be in the PTV anyway. This is how I would approach planning: I would fuse the MR T2 sequence with my planning CT, and use the cystoscopy report as well to ensure that the involved portion of the bl...
How long of a delay are you willing to accept for vaginal cuff brachytherapy either as primary therapy or as boost?
The absolute benefit of vaginal cuff HDR boost is small and 6 months delay would negate any such benefit.
What is your approach to a patient with prostate cancer with suspicion of rectal wall invasion but otherwise localized disease?
My approach in a prostate cancer patient with "suspicious" rectal involvement is to verify, in fact, if he has actual rectal involvement, or not and NOT "suspicious" involvement. I guess my point is that I WOULD BE VERY hesitant to start RT intervention without verifying if the patient had rectal in...
Does a negative staging PSMA PET in a patient with biopsy-proven recurrent prostatic adenocarcinoma change your management?
The bottom line is that you have to believe the biopsy. PSMA PET will not show microscopic disease, which is why it cannot "rule out" disease in lymph nodes or elsewhere. It is comforting when it is negative, but it is not absolute truth. A few questions; What was the PSA at the time of the PSMA PET...
Is it safe to give thoracic irradiation to a patient with lung cancer previously treated with a VEGF inhibitor?
We did a study in patients getting VEGF inhibitors and SBRT. Anecdotally we had seen some impressive (small bowel necrosis requiring surgery) and unpredicted toxicity and we were looking for a common factor that tied them together. VEGF inhibition was that common factor. These are all patients treat...
In oligometastatic NSCLC with a solitary brain metastasis and lung primary amenable to SBRT, how would you sequence first-line systemic therapy versus local therapy to the lung after treatment of the CNS metastasis?
Would generally favor appropriate first-line systemic therapy whether that be immunotherapy +/- chemo vs. targeted therapy and if at least stable disease at the next surveillance imaging (~3 months), go ahead and consolidate with SBRT. I don't think it would be wrong to do SBRT upfront here but the ...
When treating early stage breast cancer with adjuvant RT, what risk factors would lead you to include the level 1 and 2 axilla in patients with pN0(i+) disease?
I would not offer for pN0(i+) patients. It barely makes a dent in the patients that have an indication.
When do you offer PMRT for clinical T3N0 breast cancer with a pCR after neoadjuvant chemotherapy?
I think this is a very interesting question, and one about which we have relatively little data. For pathologic T3N0 disease treated with mastectomy, radiotherapy is reasonable (NCCN tells us to "consider RT") but, I believe, falling out of favor. Data from the NSABP suggest that the 10-year risk of...
What is the recommended treatment approach for stage III/IVA nasopharyngeal cancer that is p16 negative and EBV positive?
The recommended treatment approach for stage III/IVA EBV-positive nasopharyngeal cancer is induction chemotherapy with gemcitabine/cisplatin followed by concurrent chemoradiotherapy with cisplatin.This was established in a phase 3 trial that compared induction chemotherapy plus concurrent chemoradio...
How should the V10 or V12 be defined when evaluating intracranial SRS plans?
Milano et al., as part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy investigating normal tissue complication probability (HyTEC), published a review of 51 studies in 2020 and evaluated the risk of symptomatic radiation necrosis based on a defi...