Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage AEDs in patients with malignant brain tumors?
Use of prophylactic anti-seizure drugs in patients with primary malignant brain tumors is not recommended and has been evaluated in multiple systematic reviews and guidelines including a recent systematic review and well-done guideline paper from SNO and EANO published by Tobias Walbert, Elizabeth G...
Do you recommend post-mastectomy RT for a premenopausal woman with ER/PR+ Her2 negative breast cancer and Li-Fraumeni syndrome with RCBII and residual disease in multiple LNs following neoadjuvant chemotherapy?
I have been very reluctant to offer RT for patients with Li-Fraumeni syndrome as in limited published data, the risk of RT-induced second malignancy can be as high as 25%. Any potential benefit has to be weighed against the risk. In the above case, need to look at the entire clinical scenario and qu...
Would you offer radiation therapy for ovarian remnant syndrome?
I have treated a few times with mixed results to a dose of around 20 Gy.
Would you treat a patient with prostate biopsy (and or MRI) suspicious for extraprostatic extension as high risk if they otherwise have IR disease factors?
Men in the intermediate risk category are a heterogeneous group, and clinical factors can be a useful way to further stratify risk in this group. In our practice, because of an institutional outcomes study, we primarily use % positive cores > 50% as a means to select men for the more aggressive ther...
In patients receiving PMRT do you perform a boost if they have had reconstruction (tissue expanders,…)?
Ideally I think we should make treatment recommendations prioritizing the clinical features over the reconstructive approach. The benefit of the scar boost after mastectomy is unclear, and the target for the boost is also unclear, so I tend to reserve the boost for patients with multiple high risk f...
What dose and fractionation would you recommend for post-operative treatment of an isolated femur metastasis after surgical stabilization?
Interesting question.Traditionally, in Rad Onc, post operative RT after bone stabilization has been given to patients whom the operating surgeons deemed "appropriate". Some literature suggest only 28% to 50% of post-op patients are referred for post op EBRT.As such, because the data are so 'sketchy'...
Can the SIB regimen from RTOG 1005 be extrapolated to all patients requiring whole breast irradiation?
In principle, anyone who would benefit from boost could be treated with either RTOG 1005 or IMPORT HIGH regimen of SIB.
Have you ever used a "Quad Shot" regimen or other fractionation for patients with uncontrolled inguinal nodal disease?
Yes, we do for palliation like any other pelvic malignancies.
What dose/fractionation do you use for spine schwannoma?
50.4/28 fx
For a small focally positive DCIS margin in the setting of invasive disease and negative invasive margins, not undergoing re-excision, what boost dose would you use?
Yes. I would give a higher boost dose in the setting of a positive margin. In the old days, at 2 Gy per fraction, I would tx positive margins to a total of 66 Gy, and this usually worked out well. Occasionally, the patient would get some telangiectasias long-term. With Canadian hypofraction, I have ...