Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage in-field perineural recurrences in the skull base?
If it is low volume recurrence, I favor a stereotactic radiotherapy approach over 1-5 fractions.
Do you routinely offer consolidation RT to sites of previous bulky disease in stage III and IV Hodgkin's lymphoma who have a complete metabolic response on restaging PET/CT following 6 cycles of ABVD?
Update - 1/5/24Three important studies have been published in the last few years which shed light on the role of RT in advanced HL in the setting of a negative interim (and post-chemotherapy) PET-CT.The RATHL trial included 1,119 patients with IIB-IV (or IIA with either bulky disease or at least 3 s...
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
Would you recommend SBRT in the adjuvant settings for a solitary metastasis focus in the abdominal wall resected to R1 in a young and healthy patient with clear cell ovarian cancer?
If it is truly an R1 resection, I would observe and follow with close imaging.If she recurs, I would recommend a discussion for systemic therapy. If she has persistent disease that is amendable to SBRT, it is reasonable to treat. SBRT can prolong a chemotherapy holiday and dosing in the pelvis is us...
How do you dose or sequence therapy to overcome radioresistance from oligometastatic disease from RCC?
RAPPORT (NCT02855203) [Siva et al., PMID 34953600] was a phase I/II trial which used a combination of RT and pembrolizumab. RT was given with SBRT (20 Gy/1# prescribed to the 80% isodose line) or conventional radiotherapy (30 Gy/10#) when the treatment volume was in close proximity to a dose-limitin...
What treatment volume and dose would you recommend for locally advanced NSCLC with CR after induction chemotherapy?
Interesting question. I haven't yet been in this situation but for me, it would depend on which had a CR, the primary and/or nodes. If the primary has had a complete radiographic response and there is no target, then I personally would not try to target the area where it was as I personally don't li...
How do you manage acute keratoconjunctivitis following total skin electron therapy (TSET)?
Institutions approach total skin electron beam therapy (TSEBT) somewhat differently. I generally try to utilize external eye shields as much as possible. If a patient doesn't have active disease involving the eyelids or peri-orbital skin, this obviates the need for internal eye shields which reduces...
When performing GYN HDR brachytherapy with freehand needles, what strategies do you employ to immobilize the needles and prevent changes to your implant?
For over two decades, we have employed a technique using dental putty and friction collars to secure brachytherapy catheters. Initially developed to address needle migration issues in HDR prostate brachytherapy, we have successfully applied this technique to various other sites, including gynecologi...
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tiss...
When should vaccines be given if not received prior to the start of high dose radiation (40-50 Gy) to the spleen?
Mortality due to infections is increased in asplenic individuals as well as those receiving radiation therapy to the spleen. The risk is low but measurable. For example, in a large Childhood Cancer Survivor Study, the cumulative incidence (35 years) after splenectomy of late infection-related mortal...