Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
If vertebral body pain is not controlled with a single 8 Gy fraction, what non-SBRT dose scheme would you consider for re-treatment?
My recommendation regarding a second course of radiation after a single fraction of 8 Gy depends on… a) Did the 8 Gy work at all? My usual practice has been to recommend repeat radiation therapy only if the first course helped. You could argue that maybe 8 Gy “just wasn’t enough” but many studies sh...
What are your skull constraints when administering cranial SRS/fSRS?
I have never used skull constraints when delivering intracranial SRS. While intuitive to think about any adjacent uninvolved tissue as an organ at risk and limit the dose to said structure, in relation to the skull bone itself the cost of "spray" dose to the skull is much less costly than the altern...
How do PSMA PET positive nodes change your treatment recommendations after RP?
I would incorporate PSMA avid regional node findings into salvage treatment planning with regard to guiding a) nodal basin coverage extending to give buffer on most cranial node or at least to the aortic bifurcation given PSMA-LND correlate studies often showing more involved adjacent basin disease ...
If patient has multicentric triple negative breast cancer with complete radiographic response post chemo, is BCS feasible?
Not a large amount of prospective data in this space with neoadjuvant population with ACOSOG trial demonstrating feasibility overall of the approach (Rosenkranz et al., PMID 29987605). I would counsel the patient, mastectomy is still likely to be considered standard of care in this situation even if...
How would you treat an elderly patient with a well-lateralized large (ie. cT3) node negative oral tongue cancer, who is not felt to be a surgical candidate?
Would favor EBRT followed by HDR interstitial boost, if feasible.
Would you consider eliminating post lumpectomy RT in a premenopausal patient with pCR after chemotherapy for a cT1cN0 triple negative breast cancer?
We don't have any prospective data on omitting RT in this case and would not consider this approach for triple negative patients.
How would you treat an early stage rectal adenocarcinoma in a patient that had previously received EBRT prostate radiation?
Surgery.
What dose and fractionation would you recommend for palliative-intent radiation therapy for cutaneous angiosarcoma in a patient with distant metastases?
For a patient with a fairly short time horizon, 30/10 is totally defensible and appropriate. Small series have reported on a variety of other palliative regimens, for example:39 Gy/13 fxQuadShot I think one could also consider 5 Gy x 5 or 6 Gy x 5, as we know both of those are safe even in the preop...
How do you decide on the elective radiation volume when treating a lateralized node negative non-tongue oral cavity cancer with definitive chemoRT?
I recommend surgery with/without postop RT unless medically inoperable. With curative intent, use brachytherapy or intraoral cone for the boost to shorten the overall time. Irradiate contralateral neck if within 1.5-2 cm of midline.
Would you be comfortable with patients taking Juven protein powder during head and neck radiation?
Heavy in antioxidants, no. Otherwise ok.