Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What would be a reasonable radiation approach and dose for a patient with multiple myeloma with brain involvement?
I would first wish to clarify what is meant by "brain involvement."When plasma cell neoplasms of the brain occur, they are usually the result of significant marrow involvement of calvarium and/or skull base with focal intracranial extension, or plasma cell infiltration of the leptomeninges and dura....
How do you manage leptomeningeal carcinomatosis from a metastatic solid tumor?
Several factors are usually considered prior to deciding how to manage patients with leptomeningeal carcinomatosis from a metastatic solid tumor. These factors are tumor type, performance status, neurological status, the bulk of CSF disease, the extra-cranial tumor burden as well as the chance of th...
How aggressive would you be in irradiating asymptomatic bone metastases in a patient with metastatic prostate cancer?
I used to tell patients who were referred to me for asymptomatic bone mets to defer treatment until they began having pain (unless there was an impressive radiographic lesion or concerns of impending pathologic fracture or cord compression). But the multicenter, randomized trial presented at the Ame...
Is there a valid hypofractionated regimen for postop cervical/endometrial cancers given COVID-19?
There are no good prospective series of hypofractionation for cervix and endometrial cancer in the curative setting.
Should neoadjuvant chemoradiation ever be considered in the a patient with high risk rectal cancer in the setting of active ulcerative colitis?
Yes, several studies (admittedly virtually all are single institution and retrospective) suggest the risks of toxicity from radiation in the setting of UC or Crohn's are not as high as many of us previously believed. I think it is prudent to discuss the potential risks of excess toxicity with the pa...
Would you consider definitive concurrent chemoradiation to a patient with muscle invasive bladder cancer and a history of distal/sigmoid ulcerative colitis?
Ulcerative colitis is a relative contraindication to radiotherapy, but not absolute, in my view. UC can have a spectrum of acuity as well, from distant/non-active to active-undertreatment. For many bladder cancer patients, radical cystectomy is the primary therapy +/- neoadjuvant or adjuvant chemoth...
Would you consider hypofractionated prostate treatment for a patient with well controlled ulcerative colitis?
We recently performed a systematic review of the safety of radiation therapy in patients with prostate cancer and a diagnosis of inflammatory bowel disease. Three studies, accounting for 42% of the evaluable patients, profiled the treatment of patients with hypofractionation (n = 5/8 in Vanneste et ...
What is the preferred dose and fractionation regimen for cutaneous squamous cell carcinoma of the thumb?
No level-1 evidence likely exists for this relatively rare scenario, so common oncologic sense applies here: If appendage-conserving wide local excision (WLE) can be offered, do it. Post-surgical adjuvant RT is indicated if surgical pathology shows high-risk features for loco-regional recurrence: i...
Would you consider modifying the dose for focal prostate boost to other fractionation schedules?
DELINEATE was a phase II trial from the NHS which was designed to evaluate the toxicity of a simultaneous integrated boost (SIB) to the mpMRI-defined dominant intraprostatic nodule (DIL) for two fractionation schedules: conventional fractionation (cohort A) and hypofractionation in 20 fractions (coh...
Do you add a margin when treating brain metastases with SRS?
This is debatable. We use the Gamma Knife Perfexion system (with Leksell head frame) and we do not add margins when treating brain metastases. Some institutions feel more comfortable using 1-2 mm margins when using a LINAC based SRS and mask for immobilization. However, some institutions also feel c...