Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your treatment approach in patients with early breast cancer with axillary soft tissue involvement, with or without concurrent lymph node involvement?
We are fortunate that Mass General has recently published an excellent paper on this topic that helps give guidance (Naoum et al., PMID 37967296). As expected, axillary soft tissue involvement is a high-risk feature, and these patients are at high risk for metastatic disease. For example, if there i...
What is your approach to cT3N0M0 mid rectal adenocarcinoma with clear circumferential resection margins on MRI?
This is an important issue in management of rectal cancers. It is best handled with an informed discussion and decision by the patients considering the pros and cons of initial surgery versus neoadjuvant therapy. The problem is, of course, inaccuracy of pretreatment staging, with the false negative ...
How would you approach the post-operative radiation treatment volumes for a Merkel cell carcinoma of the hand?
Get a PET-CT. Treat the primary site, axillary, and probably epitrochlear nodes electively.
How do you follow patients with Bronchus Associated Lymphoid Tissue Lymphoma treated with 2 Gy x 2 fractions?
For patients with localized MALT lymphoma of the lung, in a distribution amenable to definitive RT, I would typically treat with 24 Gy in 2 Gy fractions. The risk of in-field progression with this dose is expected to be very low. Given the rarity of the presentation, I have only treated a handful of...
Which patients with breast cancer do you treat with deep inspiration breath hold (DIBH)?
My practice is similar. All left-sided patients -- DIBH and free-breathing scans. All right-sided RNI cases - DIBH and free breathing. The benefits for lung-sparing on the right side can be significant. Few right-sided with whole breast only as target, as there is generally low lung dose in these pa...
For oligometastatic NSCLC that would be otherwise considered stage 3, would you consider consolidative immunotherapy with durvalumab after definitive treatment for both the primary and oligometastatic site?
This is an excellent question and timely in light of the greater numbers of patients being referred for "definitive treatment" of limited metastatic NSCLC. I fully agree with @Dr. First Last that there are multiple reasons/justification to offer these patients IO after their "definitive therapy," in...
Is there harm in doing a radiation oncology fellowship?
Short answer: yes. Detailed explanation below. Your excellent question brings up the fact that there are currently more and more non ACGME accredited fellowships emerging (More than 20 the last time I checked!!! Some programs even have multiple fellowships, and there is even a 2 year fellowship whic...
When pre-operatively treating high grade soft-tissue sarcomas involving the chest, abdomen, or pelvis what margins do you use for CTV and PTV?
Hi, there are some recently published consensus guidelines for pre-operative radiotherapy for retroperitoneal sarcomas. These in general recommend a 1.5-2 cm CTV margin if an 4D imaging and an ITV is used, with larger sup-inf margins (up to 2.5 cm in the upper abdomen) if 4D is not used to delineate...
Would you offer radiation therapy to a patient with sigmoid colon cancer that is medically inoperable?
Interesting question. First off, sigmoid cancers are treated as a 'typical' colon cancer; therefore, radiotherapy has a very limited role outside of loco-regional palliation efforts, perhaps. Second, though the patient is medically inoperable, is the cancer actually in the sigmoid colon, and is it r...
What is the case for or against using protons for lung SBRT?
Proton therapy is a tool in the radiation toolbox to use when needing to take advantage of avoiding normal tissue. For the vast majority of cases, proton therapy is not needed for lung SBRT and of course, there are concerns about motion, low density targets, under coverage, and beam overshoot. But.....