Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your radiation approach to metastatic pancreatic tail adenocarcinoma s/p gem/abraxane and FOLFIRI now with an oligo-progressive LUL lung metastasis?
I certainly would favor metastasis-directed therapy with SBRT, given the PFS benefit observed in EXTEND, and I think the case for utilization in the oligoprogressive state is even stronger pan-tumor compared to consolidative treatment. I'd treat 50-55 Gy/5 fractions or could consider fractionating o...
When in the treatment of OA do you think it is optimal to offer LDRT?
Evidence reality check: Two well-conducted sham-controlled RCTs (hand and knee OA) were negative for clinically meaningful benefit at their primary endpoints. (Minten et al., PMID 30231990, Mahler et al., PMID 30366945). ArthroRad (multicenter randomized, single-blinded) compared standard-dose vs ve...
What is your preferred treatment for non-contiguous Stage IIA Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL)?
Prognosis of patients with early stage NLP-HL is excellent with any treatment, and multi-institutional studies have shown 5-year survival rates of 98% (Michael S. et al. Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG. Blood 2020; 13...
Should hydroxychloroquine be stopped prior to standard or hypofractionated breast treatment?
We don’t stop hydroxychloroquine for RT.
Would you omit IMN coverage in cN1 TNBC with a CR after neoadjuvant chemo?
My practice has been to offer RNI in patients with cN1 disease with pCR in axilla outside of a trial. For TNBC in this situation, I would absolutely include IMNs in my RNI fields.
What is the appropriate role for radiation therapy in patients with HCC or intrahepatic cholangiocarcinoma who are transplant candidates?
Most HCC and cholangiocarcinoma patients who are transplant candidates are often also SBRT candidates. We have used SBRT to bridge patients to transplant. These patients often have had prior liver directed therapies such as MWA, RFA or TACE. There are no randomized trials comparing different liver d...
Are there any radiation dosimetric considerations for patients with lung cancer that have had a TAVR?
No, the new valve solves a mechanical problem. It will have some metal in it, so it would be visible whether it is a mechanical or biosynthetic type. I'd suggest not having a direct beam hit it, as that is the area of the coronary arteries' origins, and avoid dose spillage to reduce late toxicity. T...
Would you use adjuvant hypofractionation (15-20 fractions) after BCT with negative margins for a patient with malignant phyllodes tumor?
We conventionally fractionate all our phyllodes patients given there is really no data currently (that I’m aware of) that supports hypofractionating this uncommon disease entity.The Dartmouth-led series studied patients using conventionally fractionated radiation.Barth Jr. et al. PMID 19424757Their ...
How do you contour the cauda equina for a lumbar spine SBRT case below the spinal cord?
I typically contour the cauda equina at the level of the upper lumbar spine just below the spinal cord based on T2-weighted MRI and utilize a 2 mm PRV. If the entire spinal canal is instead contoured just below the cord, this may lead to underdosing of the posterior aspect of the vertebral body.At t...
Could patients with smIPI >1 and poor tolerability to R-CHOP be offered ISRT after 3 cycles of R-CHOP if interim PET showed 5-PS 1-3 response?
The revised NCCN guidelines largely reflect data from studies demonstrating excellent outcomes with four cycles of R-CHOP in patients with low-risk diffuse large B-cell lymphoma (DLBCL), including FLYER, LYSA/GOELAMS, SWOG S1001, and the most recent trial, LNH2009-1B. Although each of these trials e...