Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What's your follow-up protocol for a near complete response (nCR) in rectal patients considering non-operative management (NOM)?
This is a question that comes up in our colorectal tumor board routinely. For patients with a near-complete response after the completion of TNT, we recommend repeating an MRI of the rectum and endoscopic exam ~8 weeks later. If there is still a lack of complete response, our formal recommendation i...
Are there any contraindications to Pluvicto therapy you personally use, given that there are none directly provided by the manufacturer?
In this situation, it is helpful to review the eligibility and exclusion criteria from the VISION protocol directly. These can be found at NCT03511664 (Sartor et al., PMID 34161051). Many of these patients have been heavily pretreated, including prior taxane therapy, so my main concern is that they ...
How would you manage a patient with limited dural-based metastases?
Pachymeningeal (dural) metastases come in 3 varieties – distinguishing these entities is important therapeutically. Calvarial metastases with secondary pachymeningeal (dural) extension – these tumors can be thought of as bony metastases and can sometimes be monitored on systemic therapy if modest in...
What is your preferred second-line treatment for erectile dysfunction refractory to PDE5 inhibitors after radiation therapy for prostate cancer?
When PDE5i's fail after XRT for prostate cancer, my usual progression is to offer a duplex ultrasound to evaluate penile vascular integrity and to see if the response to Trimix is adequate and one that would be acceptable to the patient. If not, the other options would include VED and IPP.
What is your radiation approach/details for regionally involved prostate cancer (N1)?
For intact cases, I usually attempt to deliver a single-phase plan with multiple dose levels in 28 fractions as detailed below:Elective Pelvic LN volume (CTVn1): 50.4 Gy/28 fx. In cases of N1 disease, I would usually include the common iliacs. When the GTVn is near the cranial field edge, I usually ...
What are the indications to treat Dupuytren's disease with radiation?
I would not offer any radiation therapy after a surgical procedure for Dupuytren's contracture. Should the patient develop recurrent nodules that progress more than 6 months following surgery, then I would consider definitive split-course electron beam therapy to deliver 30 Gy at 3 Gy per fraction w...
Is it preferable to offer hypofractionated SRT over single fraction SRS for brain metastases?
For bulkier lesions, or somewhat bulky lesions in bad locations (i.e. brainstem) I much prefer to use a 3-fraction approach, with admittedly less data to support it. We do, however, know that necrosis risks become significant with tissue V12 (single fraction) of >10-20 ml, so for patients with bulky...
How do you approach treatment of eyelid sarcoma?
I have not personally treated eyelid sarcoma but have treated SCC and adenexal carcinoma both definitively and in adjuvant settings. I have used 60 and 66 Gy in 2 Gy per fraction for adjuvant and definitive patients, respectively, with electrons using appropriate eye shielding.
In resected N2 NSCLC, what nodal pathologic characteristics prompt you to recommend PORT?
Increasingly difficult question to answer with the evolution of neoadjuvant and adjuvant treatment paradigms. We know from both Lung ART and PORT-C that the addition of PORT in completely resected patients with N2 disease improves locoregional control across the cohort as a whole; however, this did ...
What is an acceptable upper limit for ipsilateral lung V8 Gy when using the FAST-Forward regimen with high tangents to cover limited axillary disease?
I would say ipsilateral V8 is more for the ALARA principle and not based on risk of Pneumonitis, and thus would accept a higher number to cover low axillary if needed.