Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose would you use to treat an unresectable axillary breast cancer recurrence in a patient who has not previously received radiation therapy?
I usually treat GTV node between 60-66 Gy based on volume of disease at the time of treatment ( some get upfront systemic treatment to downsize and make disease resectable and final dose is based on residual disease size )
Do you offer post-mastectomy radiation for invasive lobular carcinomas?
At present we use similar indication as invasive ductal cancer although more research needs to be done as there is suggestion of different response to antiestrogen therapy ( tamoxifen vs. AI) for lobular histology and most patinets have limited benefit from chemotherapy
How is your institution incorporating MRI planning into cervical EBRT/brachy?
Our department began utilizing MRI-based cervical brachytherapy in 2014. An MRI-based brachytherapy program is multi-disciplinary effort that required support from all departments, and it took about 6 months for us to implement. We have since progressed from MRI-based intracavitary only implants to ...
Would you wait to treat a ground glass opacity lesion (minimally invasive adenocarcinoma or adenocarcnioma in situ) with SBRT until there is more of a solid component?
In general, it is understood that the appropriate indication for utilizing lung SBRT is in the setting of a diagnosis of invasive cancer, i.e., early stage lung cancer or an oligometastatic lesion. With regard to ground glass opacities (GGOs) it is understood that the differential for these entities...
Do you counsel patients on the risk of dementia following androgen deprivation therapy for prostate cancer?
No, I generally do not counsel men about this risk. The two studies from the same investigator use a data warehouse search algorithm that may not be accurate enough to fully characterize who gets Alzheimer's disease or may not be able to correct for confounding factors that may be different between ...
What is the appropriate volume to re-irradiate in a recurrent GBM?
We need to recognize there is no standard dose fractionation regimen for re-irradiation in recurrent GBM. The volume and CTV/PTV margin are heavily depended on the dose/fraction you pick for your patients, and radiation techniques. The most commonly accepted regimen is probably 35 Gy in 10 fractions...
In a patient with brain metastasis confined to the cerebellum, would it be reasonable to treat the posterior fossa only (vs WBRT)?
If the patient has favorable prognostic factors and would like to avoid memory loss associated with WBRT, I would first consider whether the patient is eligible for stereotactic radiosurgery. If not a candidate for stereotactic radiosurgery, I would consider enrollment on eligible hippocampal avoida...
How do you manage an acute herpes zoster infection (shingles) in a radiation therapy treatment field where the skin is getting a significant dose of RT?
Physician's awareness is crucial in Zoster infection. Systematic acyclovir and local Zovirax is usually very effective if caught early. A break in therapy is more detrimental than treating over the zoster. Perhaps one or two days break to stabilize zoster therapy at the most. Routine skin care along...
What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?
Although myeloma is radiosensitive, since it has caused metastatic epidural spinal cord compression, I will still offer 30 Gy in 10 fxs or 37.5 Gy in 15 fxs, a dose closer to a definitive dose for plasma cell tumors, in order to provide a more durable local control. See variant 2:ACR appropriateness...
Do you recommend holding a TKI when treating brain metastases with SRS/WBRT?
There are a few publications which help address this very pertinent question. The phase 3 trial of whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone versus WBRT and SRS with temozolomide or erlotinib for non-small cell lung cancer and 1 to 3 brain metastases: RTOG 0320 (...