Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat anal margin tumors?
Yes that is the standard of care for anal margin tumors. Even if there is a positive margin it is reasonable to consider following well and moderately differentiated tumors without lymphovascular space invasion closely and using definitive treatment as a salvage. These tumors rarely progress rapidly...
If technically feasible, would you consider SBRT for locally recurrent ampullary carcinoma in an inoperable radiation naive patient?
No. A stereotactic technique cannot improve outcome when the duodenum cannot be avoided. As in every ampullary cancer I have ever treated, you are limited to palliative doses by the tolerance of the mucosa. Larger doses per fraction only serve to narrow the therapeutic index and use up tolerance bas...
How do you sequence HDR brachytherapy boost and external beam RT for prostate cancer?
The typical sequence for our combination IMRT/HDR patients is IMRT first followed by the HDR boost about a week later. HDR is much more forgiving (substantially less GU toxicity) so the gap between IMRT and HDR is less than when we did seed boosts. However, our first clinical trials in the late 1990...
How to you sequence HDR brachytherapy for definitive prostate cancer treatment?
This is a great question, for which there are several options. I think a lot of it comes down to your department capabilities, trade-offs, what you and your team are comfortable with, etc. When starting the prostate HDR brachytherapy program at MGH, I spoke to many different centers that had it up ...
What brachytherapy dose/fractionation should be used for small cell carinoma of the cervix?
I treat a small cell carcinoma of the cervix the same as a squamous cell or adenocarcinoma as far as the RT portion of treatment. I would give 45 Gy pelvic RT (I would treat PA if involved or if there are positive pelvic nodes). I would give SIB to positive nodes to 55 Gy (2.2 Gy/fx) in the pelvis a...
Are pancreatic fiducials necessary when delivering dose escalated radiation therapy for inoperable pancreatic cancer and using cone beam CT for IGRT?
Some form of precise respiratory motion management is necessary to cover the GTV optimally. Deep inspiration breath hold or end expiratory gating are preferred. Both require a metallic fiducial for set up. We do not recommend trying to set up to soft tissue. We often use the metallic endobiliary ste...
What systemic therapy would you offer to a patient with metastatic EGFR exon 19 deleted NSCLC to the brain with isolated CNS progression while on osimertinib 80 mg and progressed through WBRT?
If this is isolated CNS progression, the answer will depend on the number of metastatic sites. This is worth a conversation with your radiation oncologist. If there are 1-5 sites progressing within the CNS, it may be reasonable to consider treating these with SRS (even if patients have had prior who...
With the presentation of HypoG-01 phase III UNICANCER trial at ESMO 2024, should hypofractionated radiotherapy be the standard across the board for breast cancer?
It would be difficult not to recommend at this time.HypoG-01 had broad criteria and did not show any differences in outcomes in terms of disease control or toxicity between 40/15 vs 50/25. RT-CHARM was all reconstructed PMRT patients showed a slightly higher risk of complications with the hypofracti...
Is prior radioembolization with Yttrium-90 microspheres for a primary liver cancer a contra-indication to external beam radiation therapy with either stereotactic body radiation therapy (SBRT) or proton beam therapy?
Great question. The original ACR SIRT/RE guideline listed previous external beam as a relative contraindication to Y90 RE.*RE is safe for patients who have had "minimal prior exposure" to external beam radiation. While there is limited published literature on the combination of RE and EBRT/SBRT, one...
Can radium-223 be given to prostate cancer patients with a history of visceral metastatic disease?
Radium-223 is a bone-targeted radiopharmaceutical. In the ALSYMPCA trial, patients with visceral metastases or lymphadenopathy>3cm were excluded. However, if a patient with mCRPC has visceral disease that resolved with previous treatment, and now has progressive osseous metastases, it would be very ...