Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
At what heart dose would you prospectively refer a patient to cardiology due to anticipated long term risks?
If a patient had prior BCT and now inflammatory, I would refer given the most likely plan for additional chemotherapy and RT. In general, I refer for cardiac oncology based on a combination of cardiac risk factors (HTN, DM, HLP), family cardiac history, anthracycline receipt, and cardiac dose (ex. I...
What elective areas are you comfortable omitting in the N0 neck for NPC?
Based on the data from China, I would consider omitting levels IV and VB for the N0 Neck.
How do you typically screen for lymphedema in breast cancer patients following RT?
Really this is a clinical issue so I follow women with routine visits and examine them for edema. I don't think there's any role for surveillance measurements or more specific metrics (per hand therapy). The patients tell you when they are concerned. In the era of sentinel node mapping, clinically s...
What precautions or modifications, if any, would you employ when considering lung SBRT for early NSCLC in a patient recovering from acute lung injury?
For a patient recovering from COVID-19 pneumonia, I would hold SBRT until the patient has recovered fully from acute infection, i.e., no more fever, cough, and/or SOB. The patient's breathing should recover to close to pre-COVID-19 pneumonia status and chest CT image showed resolution of COVID-19 ac...
In what N1 H&N patients, if any, would you consider treating the gross disease (primary + involved node) only without elective nodal radiation volume with definitive intent in order to reduce toxicity?
Madness. Not just no but bleep no. I don’t want to injure a lot of patients and discover something stupid.
Would you consider head and neck RT for a patient with pre-existing carotid blowout due to tumor involvement?
Yes. Tumor or treatment. Roll the dice. You know the outcome if you don’t. That said, I don’t recall confronting this in over 40 years. If due to tumor, I suspect that they didn’t make it to me.
In light of the recently published OPRA trial, could one consider organ preservation as a standard treatment option for appropriately selected patients treated with total neoadjuvant therapy for locally advanced rectal cancer?
I think that it is NOT appropriate to consider watch and wait as a standard therapy. The OPRA trial did not test that concept- they just showed that they get pretty good results at 3 years using this technique when compared to historical data. They have not done any type of randomized comparison dem...
How long do you wait following spinal surgery to administer SRS?
The answer depends. If separation surgery was performed, I would start sooner than later and be aware of skin dose and minimize as much as possible. Superficial dehiscence shouldn’t become problematic after SRS given minimal skin dose (if planned accordingly). If a large amount of tumor was resected...
How long do you delay post-op radiation for cord compression if there is superficial proximal scar dehiscence?
In the 2005 Patchell trial that established decompressive surgery followed by RT as the standard of care, patients started radiation within 14 days after surgery. If the skin wound isn't closed by then, don't wait around. I would get started anyway and try to treat around it with oblique beams, or u...
Is your decision to hypofractionate or boost altered by surgeon's plans for DIEP reconstruction after radiotherapy?
I would not offer pre-operative RT off trial at this time. If planning for lumpectomy, I would use my standard consideration (moderate hypofractionation standard, can consider 5 fx WBI for appropriately selected) and boost factors (age < 50, ER-, margins). It's unclear the rationale for a DIEP post ...