Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How, if at all, would adenosquamous histology affect your coverage volume compared to squamous cell carcinoma of the head and neck?
No impact
What criteria do you use to determine the utility of DIBH for breast cancer patients?
For PMRT or anyone getting RNI, favor DIBH for all (irrespective of side) to reduce lung (more important as some of the patients get TDM1 and Pembro with RT) and heart dose (as long as the patient can tolerate the procedure). For non-RNI, make a determination only for the left-sided breast based on ...
How would you approach a patient with limited stage SCLC who progressed immediately after completing chemoradiation with brain metastasis?
For 1-10 brain metastases from SCLC, consider the NRG CC009 clinical trial randomizing between SRS and hippocampal-avoidance WBRT!
Is there an optimal salvage radiation dose for relapsed post-CART disease?
While there is not enough data to definitively recommend a specific dose, we feel an EQD2 > 37.5-40 Gy is desirable for patients with limited residual or relapsed disease post-CAR T-cell. Our commonly recommended fractionations include 37.5 Gy in 15 fractions, 40 Gy in 15 fractions, and 40 Gy in 20 ...
Would you offer postoperative radiation for a patient who initially had biopsy-proven multistation N2 NSCLC but had a nodal pCR upon surgical resection+ LND after neoadjuvant chemo-immunotherapy?
I would not routinely offer PORT for completely resected N2 disease based on lack of survival benefit from LungART (have my qualms about ~90% 3DCRT and the probable impact on cardiothoracic toxicity), particularly in a patient who appears to have had a fantastic response to neoadjuvant therapy. I th...
Do you recommend sperm banking for males prior to undergoing radiation?
To the first question in the prompt, I would recommend sperm banking for any patient who was receiving a sufficiently high radiation dose to the testes and desired fertility preservation. In my practice, this are few patients, although it is an important consideration for younger patients. To the se...
How would you approach new dermal mets in a patient who recently finished chemoradiation for head and neck SCC?
Dermal mets are M1 disease. Since the patient received chemo, (s)he has a medical oncologist who should manage the case moving forward.
Would you offer XRT as bridging for all patients with limited pre CAR-T disease or as consolidation for only those with residual PET-avidity on day+30 post CAR-T?
There are no studies comparing these 2 approaches. However, given the detrimental outcomes of post CAR-T relapses, I would consider maximizing peri-CAR-T treatments as much as possible as long as the toxicity profile is reasonable, and would not view these 2 approaches as mutually exclusive. I would...
Do you modify the external beam plan that follows if a patient develops prolonged urinary retention after LDR?
This situation is one of the reasons that I prefer to sequence LDR brachytherapy after external beam radiation. In a patient who develops urinary retention following upfront LDR brachytherapy, I would delay external beam until they are able to void spontaneously if at all possible. This could take w...
How would you treat high risk prostate cancer in a patient with autonomic bladder dysfunction?
Personally, I have not treated a large number of such patients, but they've generally had this problem due to diabetes or Parkinson's disease. However, it might be prudent to wait for the workup for an etiology before starting radiation therapy. For high risk patients, you're generally considering a...