Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach consolidative rectal irradiation for a patient with liver-confined metastatic rectal adenocarcinoma, who has sustained a near-CR after CAPEOX, capecitabine, and ongoing bevacizumab?
Yes, they are curable with liver directed therapy, I would treat with curative intent non-operative management. If they are not curable, would not treat unless until progression.
What staff members would you recommend to start a Lu-177 PSMA therapy program?
The manuscripts below are thorough and provide the information needed.Local context matters and the setting - Nuc med vs in rad onc vs other, as well as the resources available in your clinical setting, and finally any extended services you might perform (e.g., dosimetry) you might need more personn...
When treating sinonasal undifferentiated carcinoma (SNUC) with induction chemotherapy followed by definitive chemoradiation, do you include the entire pre-chemo volume in your high-dose CTV?
Yes
How would you treat a patient with a prior history of an early-stage breast cancer who now has a 5 cm tumor in this ipsilateral breast with nodal involvement?
One of the important things is the time from the original course of RT. The longer the time from the 1st course the fewer wound complications and toxicities we see. She now has cT3N1 (at least per discussion) triple negative breast cancer. A few options are given plan for mastectomy: If pCR, can co...
What treatment would you recommend for DCIS incidentally found in pathologic specimen following breast reduction surgery?
This is a challenging situation that can be seen in spite of evaluation prior to definitive procedure. I would agree with an MRI after the patient heals to look for any obvious residual disease. In the absence of a completion mastectomy which is usually unlikely, I would favor a course of whole brea...
Are there any potential benefits to irradiating the partial breast with an MR-linac over conventional linac?
The group at WashU has done a great job publishing on this topic (Price et al., PMID 34624406).At this time, I don't think we can say there is a clear benefit to MR linac over conventional CBCT when it comes to cancer control or toxicity, though there may be dosimetric benefits (that could translate...
What is your approach to adjuvant vaginal cuff radiation in patients with prior definitive pelvic radiation therapy?
I do take the previous dose into account. Sometimes use a multichannel cylinder and try to control the rectum and bladder dose. Also, prescribe lower end of acceptable dose schedule like 6 Gy x 5 to surface or 4 Gy x 6 to surface.
In a patient with rectal adenocarcinoma and involved gluteal lymph nodes, what would your elective lymph node volume include?
I think the most important issue to address in this case, is how disease accessed the subgluteal space. I had a case like this in a patient with a very deeply invasive disease. During chemoRT, the patient required a diverting ileostomy after they developed a recto-cutaneous fistula due to rapid tumo...
How would you sequence treatment of a synchronous IC1 high-grade serous ovarian cancer and cT3N1 rectal cancer?
Do you dose escalate a patient with high risk prostate cancer who refuses ADT due to potential side effects?
I would treat the elective pelvis to around 50 Gy with a simultaneous boost to the LN to as high as tolerable based on proximity to the bowel. The prostate should be taken to normal dose-escalated levels depending on your fractionation, and you can add a microboost to a DIL. I generally do not add a...