Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer hippocampal sparing whole brain radiation for patients with brain metastases due to ES-SCLC?
Until we have built-in auto-segmentation, I find the RTOG contouring atlas very helpful for manual contouring of the hippocampus. I tend to use the lateral ventricle as my main landmark, and look for the circle of gray matter located medial to it. Once I've drawn a hippocampus, I'll look at it in th...
What dosimetric considerations, if any, do you have when treating a lateral dominant intraprostatic lesion adjacent to the levator ani with simultaneous integrated boost?
I am not aware of any data directly evaluating the effect of elevator ani dose on GI toxicity/ QoL in patients undergoing prostate RT with intraprostatic boost. There have been prior studies on this topic in the prostate cancer population receiving homogeneous dosing, however. For example, Schaake a...
How do you follow patients after SBRT for NSCLC?
When we started our lung SBRT practice almost 13 years ago, the follow up schedule was based on trying to measure the benefits and impact of the therapy in a fairly structured fashion so that we could develop expertise in understanding outcomes, radiographic changes, patient experience, and treatmen...
For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?
This is an important question; however, the answer is unknown. The key outcome that should be the focal point for the best treatment option, is which treatment strategy results in the most optimal patient reported quality of life and bowel function. Currently, this remains void of prospective, rando...
Is it acceptable to treat patients with limited, asymptomatic brain metastases and EGFR-mutant NSCLC with upfront TKI?
Though some clinicians have been exploring the idea of targeted therapy for EGFR mutant brain metastases, this has been done in the absence of strong evidence. Reasons for pushing this idea are that sometimes the lesions seem to respond, and this has been seen in some single arm studies and anecdota...
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...
How does a low Decipher score impact your management of patients with unfavorable intermediate-risk prostate cancer?
In the NRG-GU010 trial, those patients were randomized to RT alone vs. RT + ADT, reflecting a hypothesis that these patients may not need ADT, although we will have to wait for the trial to read out to be sure. However, what we do know is that with widespread use of MRI-guided biopsies and PSMA PET ...
How do you treat non-small cell lung cancer presenting with SVC syndrome?
It depends on a number of things. I would say if the patient presents with metastatic disease, I would still favor a 5-10 fraction (20-30 Gy total) approach to palliate, and maybe consider a stent if IR feels it is possible. Alternatively, if this is locally advanced, then I would attempt definitive...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
What are your typical dose and fractionation schedules for post-prostatectomy radiotherapy for a patient with involved pelvic lymph nodes?
I typically use conventional fractionation for post-prostatectomy RT. The recently published experience from Wisconsin showing a continuous development of significant late effects with longer term follow-up for moderate hypofractionation in this setting, I believe, is cause for concern, so I have no...