Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there an "ideal" method for abdominal motion control when treating upper abdomen malignancies?
When using doses that potentially exceed OAR tolerance (specifically luminal GI,common and main bile ducts, liver) in the upper abdomen it is important to not only have a solution for organ motion, but some form of high quality image guidance. When giving a BED of <60 Gy, there is no need to use the...
What are your indications for including the contralateral neck when planning postoperative primary and ipsilateral elective neck radiotherapy for a well lateralized buccal squamous cell carcinoma?
No indication for contralateral neck RT in cases of buccal primary ca. If there are high risk features in the ipsilateral neck or primary tumor, LRR risk will mostly be confined to those sites.
What rates of radiation-induced secondary malignancies do you typically quote to patients in their 30s-40s?
This is an excellent question. Current breast cancer treatments yield great local control and overall survival rates; thus, leaving long term toxicity for breast cancer treatment as a major concern. As a resident, I often quoted patients the risk of secondary malignancies from radiation therapy to b...
Is PMRT routinely recommended for all patients with positive lymph nodes after neoadjuvant chemotherapy?
This is a good question. In general at MD Anderson, we tend to recommend post-mastectomy radiation therapy for patients with residual micro- or macro-metastatic disease in the axillary nodes after neoadjuvant chemotherapy. This recommendation is strong when the patient had clinical stage III disease...
How do you treat newly diagnosed low volume metastatic hormone sensitive prostate cancer in light of new data from STAMPEDE presented at ESMO 2018?
In the prespecified subset of men with mHSPC and low volume of metastases (CHAARTED criteria of 4 or fewer bone metastases and no visceral metastases), there was a 32% improvement in overall survival (HR 0.68 95% CI 0.52-0.9) which was statistically significant and is clinically significant. Given t...
When do you consider elective pelvic nodal irradiation for unfavorable intermediate risk prostate cancer?
I consider elective pelvic nodal irradiation for patients classified as unfavorable intermediate risk by virtue of having Grade Group (GG) 3 disease, especially if they have high volume disease (50% or more of the cores are positive). These patients have a risk of lymph nodal involvement that is in ...
Would you offer PMRT to ER/PR+ patients with synchronous bone metastasis?
This is a more common scenario despite data suggesting a local survival benefit with the addition of local therapy to patients with metastatic breast cancer. With synchronous bone mets- we usually start with systemic therapy, ER+ would be endocrine therapy + CDK 4/6 inhibitor commonly. If stable/res...
Should rectal spacing only be considered routinely for patients who are at elevated risk of rectal toxicity?
I think some caution needs to be injected here (pun intended) before people decide to make a change in practice based on unpublished data. Let me remind everyone that the devil is in the details of the treatment technique, dose constraints, dose-fractionation schedule, treatment delivery technique, ...
Are there any factors which would lead you away from recommending active surveillance in low risk prostate cancer?
A healthy male with a BrCa mutation Or Any male with at least 50% + bxs Or The presence of Perineural invasion Or PSA density more then 0.30 may be a new indication after the AUA this year Would prompt a mpMRI and then fusion bx of any PiRADS 3,4 or 5 areas to rule out grade 4 pc
Is it appropriate to use electrons to treat a fibrosarcomatous DFSP of the face s/p R1 WLE?
If the geometry of the target volume is conducive to electrons, it is reasonable to consider. I might also consider use of a custom compensator such as: https://dotdecimal.com/products-proton-electron-or-photon-therapies/electrons-electron-treatment/bolusect-bolus-electron-conformal-therapy/