Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For a patient with intracranial mets for ES-SCLC who undergoes resection, do you routinely offer post-op SRS to the cavity, or do you proceed with WBRT?
While Whole Brain Radiation Therapy (WBRT) has been the standard, stereotactic radiosurgery (SRS) to the surgical cavity is increasingly being used to minimize neurocognitive decline. However, the issue is especially more nuanced for an ES-SCLC (we don't know whether the primary has been controlled ...
Can the addition of posterior axillary boost (PAB) for breast cancer increase the risk of brachial plexopathy?
In the era of 3D volume based planning, it is important to contour the nodal regions and optimize coverage to the volume. In the 2D era, people use to prescribe to mid axilla and a PAB was commonly used. We know now that axillary nodes are far more anterior then that. To cover these nodes, we use an...
What dose contraints do use for the pulmonary artery and vein when treating with a lung lesion with SBRT?
I actually defer to my dosimetrists. They are cautious and based on consensus, not actual facts. The “ultra central” concerns are about the potential for rupture. The counterpoints are about control and whether there is evidence that either margin or dose will better lead to control. Whether the tum...
In a patient with locally advanced cervical cancer that has extensive residual disease (>7 cm in greatest dimension) after chemoradiation, how do you weigh the geometric advantages of a Syed-Neblett template against the superior toxicity profile and outpatient feasibility of an advanced hybrid applicator?
Kilar et al., PMID 41737510, explains applicator selection. If residual disease is less than 4 cm on either side (still a total of 7 cm), a hybrid with straight and oblique needles can help to cover the disease. However, if it is more than 4 cm on one side, then you have to look at geometry, and som...
What is the role of radiotherapy in medically inoperable, large and or recurrent aggressive basal cell or squamous cell cancer of the skin in high risk areas?
When treating small to moderate size skin cancers in an area with good circulation (face, trunk, upper extremity) my standard regimen for BCC is 4500 cGy in 15 fractions, and for SCC I use 4800 cGy in 16 fractions. For large tumors I use 5000 cGy in 20 fractions for both histologies, and this is als...
In what circumstances would you recommend adjuvant radiation for a keratocanthoma with SCC after resection?
KA by itself (in the absence of SCC) is at the interface of benign and malignant. In a pure KA, if margins are negative, no further RT is needed. If there is SCC mixed, as can happen even with BCCs, the adjuvant RT indication rules pertaining to SCC prevail.
Would you omit IMN coverage in cN1 TNBC with a CR after neoadjuvant chemo?
My practice has been to offer RNI in patients with cN1 disease with pCR in axilla outside of a trial. For TNBC in this situation, I would absolutely include IMNs in my RNI fields.
Is imaging necessary after Pluvicto or Lutathera infusions to verify the dose?
The term "verify the dose" can mean two distinct things, with different answers: Confirming biodistribution/injection integrity (that the agent went where intended and was not extravasated): a single planar or SPECT image is a reasonable, easily obtained check. Quantitative dosimetry (measuring abso...
For a cervical cancer patient who had involved para-aortic lymph nodes, how much higher do you extend the superior edge of your field if there are nodes close to the renal vessels (i.e. usual superior extend of field)?
In this dataset from us, next station was retrocrural nodes with involvement more than 25% and for that reason, we extend CTV for 2-3 cm above renal vessel to include retrocrural nodal region and space.Kabolizadeh et al., PMID 23849691
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...