Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When offering APBI, if a patient has invasive ductal carcinoma and DCIS, do they need to fill suitability criteria for both, or does the DCIS criteria only apply to pure DCIS?
In such cases, I use the criteria for invasive cancers. I only use DCIS criteria for pure DCIS.
Would you recommend removal of pec muscle for a positive microscopic deep margin post mastectomy?
Pec fascia and muscle involvement are independent risk factors for local relapse even with a negative margin. The situation is not common but for microscopic positive margin, have offered PMRT with an additional boost to the area of close margin (60-66 Gy and used pre-surgery imaging to identify the...
Do you routinely perform mammograms for women that underwent nipple-sparing mastectomy with reconstruction after a breast cancer diagnosis?
We don’t perform mammograms routinely for this subset unless clinically indicated.
What target volumes do you use for cavity SRS following surgical resection of brain metastases?
Update: Essentially, my answer is the same. I'd add that often the sx tract is covered with PTV and I might extend that if its close. But surgical tracts can be extensive. There's a nice paper by Byrne et al. out of MGH from the excellent Helen Shih's group. This is a good option to consider if you ...
When is it appropriate to use SBRT in treating lung metastases (oligomet, up to 3 mets etc.?)
Patients with lung metastases rarely die directly from their pulmonary disease. Rather, systemic disease progression is typically the obstacle. Therefore, I would judge that the most critical question is not "how" to treat but "when" to treat. With limited clinical trials to guide management, this r...
How do you define PTV margins for lung SBRT using breath hold technique?
Prior to even creating a PTV the decision of when to use/not use ABC is critical. Most medically inoperable lung patients don't handle ABC mediated breath-holds well, and would be better treated by abdominal compression and 4D CT ITV techniques. In our practice <10% of stage I NSCLC are treated with...
What is your preferred dose-fractionation for ultra-central lung tumors?
There is a lot of practice variability with ultra-central stage I inoperable lung cancers around the country/world. Some providers prioritize "doing no harm" and prescribe more conservative dosing schemes (2.5 to 4 Gy fractions). Undoubtedly, there is a lower risk of complications with this approach...
How do you follow patients after prostate SBRT?
At Fox Chase, we follow our prostate SbRT patients the same way we follow all our prostate patients. Specifically, their first post-treatment visit is around 4 months with a PSA and testosterone prior to the visit. They are then seen every 6 months with labs. Typically we alternate our vists with th...
Would you offer prostate SBRT to a patient who cannot have an MRI?
Agree with Dr. @Dr. First Last, that yes, in a global sense, it's feasible. My only caveat - we routinely use the MRI to help delineate the urethra, as our institutional prostate SBRT dose is 40 Gy in 5 fractions to PTV, with hard constraint of limiting DMax of urethra to < 42 Gy. I routinely plan t...
Do you apply a tracheal dose constraint during thoracic radiation and/or reirradiation?
I have used Dmax BED3 < 140 Gy for initial treatment (based off experience with 60 Gy in 15 fractions considered a conservative choice for ultra-central tumors). It was noted that below Dmax BED3 140 Gy there was no high grade toxicity per Chen et al., PMID 31075543. Also, see Lodeweges et al., PMID...