Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you handle bladder filling for treatment planning MRIs for prostate cancer?
We use T2 cube sequence for MRI. When done for RT planning, it takes 5 to 7 minutes for acquisition.
Is axitinib with concurrent spinal RT safe?
We have always been cautious about giving axitinib concurrently with CNS radiotherapy. There is pre clinical data suggesting radiosensitization with high dose single fraction radiation due to VEGF effects on the endothelium (Rao et a., PMID 24794795.) Out of an abundance of caution, we typically sto...
What is your approach to treating gliomatosis cerebri?
I think a number of considerations have to be taken into account: - Symptoms, KPS, patient age, prior therapy, and underlying morbidities... At present, there are no clear biologic prognostic factors and so clarifying whether the cases represent true gliomatosis is essential. A recent consensus conf...
Does the presence of multifocal disease impact your decision on whether or not to recommend post-mastectomy radiation?
Yes, it does however multifocality is just one of several risk factors that predict for the likelihood of local recurrence and it is far less important than % nodal positivity, tumor size, age, +margin, multicentricity or adequacy of lymph node dissection. By itself, the presence of multifocality i...
For which patients is frameless gamma knife radiosurgery most appropriate?
Patients who are good candidates are those with tumors that obviously need fractionation (large size, near optic chiasm, etc.) AND are very compliant / able to participate in their care. Noncompliant patients will be impossible - there will be too much motion. It's difficult for most patients to tol...
How do you approach the use of IMRT/VMAT boost for grossly involved internal mammary nodes in breast cancer patients?
We have to get over this idea that "IMRT/VMAT IS BAD FOR BREAST CANCER" mentality. ASTRO pursued this for nearly a decade, but finally removed from "Choosing Wisely". VMAT/IMRT is a tool like any other tool. It is (usually) as good or as bad as the contouring and treatment planning. In some cases, ...
For pediatric Ewing sarcoma, what is the role of metastatic site consolidation?
The COG protocols recommend that all sites of disease including metastatic sites are addressed with local modality measures (obviously this may not be always feasible, e.g. bone marrow disease). Metastatic sites are usually radiated at the end of treatment after systemic chemotherapy.
Do you recommend carotid ultrasound screening at some point post definitive H&N XRT?
That is a great question and something that has frequently crossed my mind. However, this is not something I have routinely ordered for my patients. One of the reasons is the lack of adequate long term follow-up. This is usually seen a few years post-RT and many patients are lost to follow-up 4-5 ye...
In what situations can short course RT (5 Gy x 5fx) be used instead of chemoRT for rectal cancer?
My take? Preop short course RT is grossly underutilized in the US for locally advanced rectal cancer.Progress is slow but we are getting there; the 2019 version of the NCCN guidelines lists SCRT followed by resection as a standard option for patients w/ T3 or N+ disease as long as the CRM is clear b...
In the setting of recurrent breast cancer localized to the chest wall (no prior RT), do you allow concurrent abemaciclib or Enhertu with post-operative comprehensive chest wall irradiation?
We try to hold off as data on concurrent is very limited and in adjuvant studies, it was done sequentially.