Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there an age cutoff at which you would recommend against radiosurgery for a schwannoma or trigeminal neuralgia in someone who is a good surgical candidate with no comorbidities?
Personally, I do not have a specific age cutoff, but do have a careful discussion about secondary malignancy risks in a younger patient. With younger patients with schwannomas, one has to be careful about neurofibromatosis as there may be a higher risk of secondary malignancies from radiation. With ...
Do you consider multiple sclerosis a contraindication for SRS?
The answer to this question in my opinion is in two parts :1. Looking at the data in detail from this paper:a. Three of the 6 patients with MS had brain mets and recieved the higher doses - and had no complications.b. The one patient with a facial schwannoma developed facial palsy - which is not unu...
What group of patients is suitable for breast radiation using high tangents?
I could consider high tangents for patients with ER+ disease and N1mic. If patients have ER- and N1mic or N1 disease with macromets, I tend to add RNI.
How would you post-operatively manage a peripheral stage I small cell lung carcinoma s/p upfront wedge resection with an R1 microscopic positive margin along the staple line and visceral pleural invasion?
I would advise 4 cycles of chemotherapy followed by immunotherapy. It would be hard to define a “reasonable radiotherapy target” with visceral pleural involvement and surgical suture line, which is true in NSCLC as well. I would not recommend thoracic or prophylactic cranial radiotherapy.
Is there data, or even anecdotal reports, of cosmesis or capsular contracture of a previously augmented breast after lumpectomy and hypofractionated whole breast radiation?
So, you will probably encounter more people who admit to being abducted by UFOs than using HFRT in someone with a cosmetic or reconstructed implant. I've even heard people argue that they go at 1.8Gy/fx as opposed to 2Gy "just to be on the safe side" with regard to capsular contracture. The fact of ...
In the era of neoadjuvant chemotherapy, how reliable is biopsy for assessment of LVI to make decisions about PMRT?
If bx is negative for LVI and final path is negative after NACT, then would not speculate about the possibility of LVI as risk factor for PMRT decisions.
What is the best radiation dose to treat primary cutaneous B cell lymphoma?
For a small (1-2cm lesion) of these subtypes, 30Gy is usually adequate. For larger/thicker lesions, consider 36Gy. Electrons with bolus or orthovoltage/superficial therapy.
What is the shortest interval you would consider to deliver re-irradiation for a recurrent glioblastoma?
Re-irradiation (assuming infield local progression) doesn't usually get discussed until more than 6 months following initial radiation therapy, likely because any increase before that is going to be possible pseudo progression. But after that point if there is increasing contrast enhancement suspici...
What is the best dose to treat splenomegaly with pancytonenia in the setting of myelofibrosis?
I have treated occassionally and have recommended 20 cGy to 25 cGy alternate day x 3 or 4 fractions It works well as spleen is a very radiosensitive organ and does not require doses above 150 cGy
How do you choose between moderate hypofractionation vs SBRT for intact low or intermediate risk prostate cancer patients?
In low-risk prostate cancer patients, hypofractionated regimens have been proven to be equivalent to standard fractionation in randomized studies (e.g. RTOG 0415 - Lee et al., PMID 27044935). Mulitiple non-randomized studies have shown that SBRT appears to have comparable results to historical contr...