Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the highest dose to which you treat a locally advanced esophageal cancer with a stent in place?
Shin et al., PMID 15640412 Since it appears that covered temporary or permanent stents are relatively safe with radiotherapy and that the palliative and curative doses are the same, 5040 cGy should be reasonable.The addition of chemotherapy will definitely increase toxicity but may be considered for...
How does pathological skin involvement (i.e. nipple, epidermis) but not clinical skin involvement change your recommendations regarding PMRT in the absence of other risk factors?
Not by itself, as sometimes it is just a function of location rather than stage and biology but in conjunction with other factors, I do consider for possible PMRT. Katz et al., PMID 11395242
How do you approach the treatment of breast cancer with enlarged but indeterminate breast nodes?
Since T2 no, pre-op chemo plus IO and then surgery which would involve SNLN plus removal of targeted node (even though negative would add clip at biopsy).
How would you manage recurrent laryngeal papillomatosis requiring multiple resections of lesions with pathology never revealing any degree of dysplasia?
There are limited data but some exist.If no other options and the patient understands the risks, it may be worth exploring.Byhardt and Almagro, PMID 3282424GALLOWAY et al., PMID 13826182
What are the current timing recommendations for initiating radiation after lumpectomy?
For me, this is dependent on the RT technique and plans for chemotherapy. If planning partial breast (regardless of plan for chemotherapy), I will recommend the RT prior to chemotherapy. I will usually simulate 3-4 weeks post-op and then start RT a week later. If planning whole breast, if no plan f...
For patients with metachronous isolated oligometastatic cancer of gynecologic origin to the supraclavicular fossa, do you prefer standard fractionation therapy to cover the entire supraclav or SBRT to the involved nodes?
Have preferred treating the entire region with sib boost to node.
When future immunotherapy is anticipated, do you alter brain metastasis SRS dose, margin, fractionation, or other factors in an attempt to decrease the risk of symptomatic radionecrosis?
No, I do not alter my radiotherapy volumes or dose for either active or planned immunotherapy. Much of the current data with concurrent ICI and SRS is from small retrospective observational cohorts but in general, meta-analyses of concurrent PD-1/PD-L1 inhibitors with SRS have demonstrated improved ...
Would you offer whole-breast RT to a BRCA-positive patient who has multifocal recurrent disease after APBI?
Before considering re-irradiation, I would counsel this patient extensively that they should have a mastectomy in this situation given the BRCA2 positivity, and recurrence vs. new primary < 2 years after treatment with RT.If the patient absolutely refuses mastectomy, re-irradiation could be consider...
How do you approach a prostate cancer patient with oligomet disease on PSMA PET?
I think there is a spectrum of 'PSMA-PET Avid lesion suspicious for metastasis'. In some locations, such as ribs, I worry more about false positives. For lesions with PET avidity without CT correlate, I worry about false positives and may advocate for a biopsy if it will change the treatment plan. S...
When do you consider replanning patient if body contour is off on CBCT but PTV is aligned to prostate?
When reviewing the CBCT for a prostate case, I first look at the PTV. I make adjustments as necessary. Then, I look at the rectum. If anteriorly, it approximates what it looked like at simulation, I proceed with treatment. If it appears substantially off, I may consider having the patient come down ...