Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Which cisplatin regimen is preferred for concurrent chemoradiation for definitive treatment of muscle invasive bladder cancer?
I tend to use 35 - 40 mg/m2 once weekly, ideally on Mondays (I think that SN1806 is using 35 mg/m2 weekly).
How do you manage a stenotic airway following SBRT or hypofractionated radiation to a central lung tumor?
I haven't read much about this in the literature and my quick search doesn't reveal much about it either. So, I'll give you my clinical wisdom on it and you can take it with a bunch of grains of salt. The issues that I've faced with a stenotic airway have been in the context of shortness of breath a...
For invasive ductal carcinoma with micropapillary features s/p lumpectomy, is bolus needed when treated with adjuvant whole-breast RT?
When using WBI, I don't typically bolus tangential fields. If superficial cavity and you are concerned about dose to cavity, I try to use 6 MV photons for tangents. For very superficial cavities, if you want to be sure, you can MOSFET over lumpectomy incision and if low, can add bolus over the incis...
What dose constraints do you use for OARs when treating with breast IMRT?
We follow dose constraints from ongoing NRG studies of breast plus RNI with the only difference being, to focus more on dose homogeneity and make sure V 105 for ipsilateral breast is <10%, and mean heart dose of heart and LAD if possible, below 2 Gy.
What would be your post-operative therapy approach for a high grade neuroendocrine carcinoma of the thymus?
Postoperative RT.
How soon after valve replacement would you start thoracic radiation for NSCLC?
Depends on the valve replacement method, if open heart, then one would need to wait until the scar has healed. If done transcatheter, one could start much sooner. I'm not aware of any data regarding outcomes and timing RT post valve replacement. Most of the data I've seen is for patients who had pri...
How does urinary obstruction impact your choice of therapy for metastatic or locally advanced prostate cancer?
Bladder outlet obstruction due to locally advanced prostate cancer is typically due to bladder wall and ureteral orifice invasion and T4 disease. These patients can suffer from pain and urinary obstructive symptoms for long periods of time despite the use of ADT, ADT plus AR inhibition, or ADT plus ...
Are there any whole breast RT techniques or modifications to optimize cosmesis for patients who had prior breast augmentation?
There are various approaches one can take. If not suitable for APBI then one can do partial breast with tangent beam like IMPORT LOW which also decreases exposure of implant and can help reduce the probability of worsening of cosmetic outcome. The goal is to deliver as homogenous dose as possible wi...
How do you position patients in a prone belly board for reproducibility and optimal small bowel sparing for rectal cancer treatment?
The bowel either falls forward or it doesn't on the commercially available belly board device. I don't think that you can position patients differently to achieve better displacement of small bowel, but we have never studied this question. The patient's position is very reproducible day to day makin...
Are there situations in which neoadjuvant chemoimmunotherapy + surgery would be preferred over chemoradiation + consolidative immunotherapy for stage III lung cancer?
We are good at controlling tumors of one billion cells (1 cm size), less so for one trillion (10 cm). From a radiobiology point of view, when I see a resectable T4 tumor due to size over 7 cm, I usually ask my surgeons if they can please take it out. You suddenly get rid of half a trillion tumor cel...