Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you treat pre- or post-chemotherapy nodal volumes on a patient with NSCLC following induction chemotherapy?
After induction chemotherapy, I treat all initially involved nodal stations to a definitive dose. If there is improvement in the parenchymal disease, I consider reducing my volumes to the post-chemo target, though I do so cautiously and often encompass that region with the CTV as well.
How do you determine your treatment volumes when treating with chemoradiation for bladder cancer?
Good question! The fields for bladder preservation with chemoradiation have not been standardized, and there are multiple reasonable options based on trials/experiences for certain fields. In general, it is important to try to minimize dose of RT to adjacent tissues that are more sensitive. Because ...
How do you approach repeat SBRT in the abdomen, specifically when considering constraints for bowel and mesenteric vessels?
Great question with no clear guidelines. If it was the same lesion of prior RT, I would consider other liver-directed therapies as I would worry about the ability to get in meaningful dose. If it was a different lesion, I would create a cumulative plan and try to minimize bowel dose aggressively. If...
Do you ever use VMAT for breast cancer?
We do use it for RNI if can’t meet OAR constraints or when doing SIB boost. Aim for V 20 < 25% for ipsilateral lung and mean heart dose of <2-3 Gy depending on the importance of covering IMN.Certainly, coverage and conformity are better with VMAT. Low dose volume is larger with VMAT but prescription...
How do you approach a patient with undifferentiated pleomorphic sarcoma encasing the spinal cord post radiation for neurological deficits for further management?
We will need some more information here. Did the patient present with cord compression? What level of cord is involved? Is the tumor causing functional issues in the patient (paralysis, bladder issues, etc.)? What was the dose of radiation used? Was this definitive RT or palliative RT? Is there any ...
Does triple negative breast cancer influence your decision to boost an older patient post lumpectomy?
Yes. The phenotype of breast cancer does predict the risk of relapse in the elderly population as well. For that reason, we would offer a boost in all triple negative patients, irrespective of age. In a recent update of the Toronto–British Columbia (TBC) randomized study for older patients with node...
How would you approach subtotal resection of a sarcoma of the scrotum/groin with grossly positive margin at the base of the penis?
These are clinically challenging situations. I would image to see if there is gross vs. microscopic disease. I would also have a surgical colleague evaluate to see if re-resection is possible to remove gross disease if present and obtain negative margins. With respect to adjuvant radiation, histolog...
How do you consider the role of probiotics for mucositis mitigation in patients receiving head and neck radiotherapy?
This is a very interesting study and I am excited to see continued studies into symptom mitigation for definitive chemoRT. I currently offer Ssk12 to my patients undergoing H+N RT (definitive or adjuvant). I see little potential downside as it is a relatively inexpensive intervention and they report...
Do you evaluate patients for low health literacy prior to discussing treatment options?
To answer this question - I do not routinely evaluate for low health literacy in my patients. This may not be the correct approach, but here is my rationale. I assume low health literacy and work up from there during each consultation. Even patients who are highly educated and/or have a background i...
Would you recommend PMRT in a patient with a triple negative cT2N0, ypT2N0 metaplastic breast cancer s/p NAC, mastectomy, and SLNB?
I would favor it, as these metaplastic tumors are aggressive triple-negative diseases with mixed responses to chemo. In this case, lack of any response and residual of more than 2 cm for this histology, I would favor RT.