Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose do you use for palliation of a large lung mass invading ribs and causing pain?
30-35 in 10 is rarely wrong. I tend to favor shorter courses for palliation; however, when the mass is large, I still kinda believe in the Rs of radbio. If doing in 5 fx, would aim for 25 Gy rather than 20, approaches BED of 30 in 10, and if expecting limited life expectancy, unlikely to experience ...
Should a lumpectomy cavity boost be given to cN0 patients who receive neo-adjuvant chemotherapy and have a path CR, if planning to complete hypofractionated whole breast radiation?
There is no prospective or retrospective data in this setting but we routinely boost this patients, as usually NACT is used for triple negative, Her2-neu positive, or higher T disease and thus, the rationale for the boost.
What adjuvant therapy is recommended for a patient treated for a WHO grade 3 meningioma s/p GTR and adjuvant radiation one year ago, with negative brain MRI, who now presents s/p selective neck dissection of a enlarged lymph node with pathology confirming WHO grade 3 metastatic meningioma?
This is an uncommon but increasingly recognized scenario. In full disclosure, I have only treated a handful of cases of disseminated anaplastic (Grade 3) meningiomas.In the case described above, cervical lymph node metastasis from a WHO grade 3 (anaplastic) meningioma indicates systemic disseminatio...
In light of the ROADS data, how are you choosing between intraoperative tile-based radiation therapy (TBRT) and postoperative SRT for newly diagnosed resectable brain metastases?
In light of the ROADS data, I would be cautious about broadly changing practice at this point. While the local control benefit with cesium-131 GammaTile is impressive and biologically plausible, reported OS is much harder to reconcile. A 26% absolute improvement in 2-year OS from a local therapy int...
What dose would you use to treat amyloidosis involving sciatic nerve for symptom relief?
20-24 Gy/10-12 fxs will likely be beneficial based on extrapolation from other reported sites. Cooper et al., PMID 28958583 Meier et al., PMID 27689460 Harris et al., PMID 33434319 Tracey et al., PMID 37732696 Monroe et al., PMID 14769766 Neben-Wittich et al., PMID 17625086 Truong et al., PMID 22270...
What is your radiotherapy approach for a patient presenting with simultaneous stage IIA limited stage SCLC and stage IIIC cervical SCC who is receiving standard treatment for both?
Tough case. I've done one for cervix and NSCLC in a similar situation where we treated simultaneously. The only difference is I would avoid concurrent etoposide during RT and would only add IO and etoposide after completion of radiation. The patient would need support with nutrition, especially if t...
What is the key to becoming an outstanding radiation oncologist?
I am not sure that my life experience qualifies me to answer such a big question but in attempting to give you my opinion, I have drawn upon the behaviors and values of my mentors and others in the field who made a significant difference in the lives of their patients, colleagues, and students. If I...
What dose constraints do you use when treating a patient with bilateral breast cancer with RNI?
This article highlights lung, heart, esophagus, and dose homogeneity constraints we aim for when treating bilateral breast cancer and RNI. Li et al., PMID 41272934
Should we delay adjuvant breast radiotherapy for early stage breast cancers as the COVID-19 situation evolves?
This is a very tough question given the unprecedented nature of this pandemic and the fact that its duration is unknown. Recommendations will likely vary based on the density of cases in a specific geographic location and will undoubtedly change frequently given the rapidly evolving nature of this s...
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...