Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a concern for using FFF beams in single isocenter multi target lung SBRT?
Fun, if forgotten, factoid: in the early Indiana University experience, Bob Timmerman and Lech Papiez designed milled compensators for the purpose of steepening the dose gradient across the profile of the beam. The basic idea was to emulate the steep gradients of GammaKnife beams for the purpose of ...
Is there a role for definitive radiotherapy in patients with de-novo metastatic cervical cancer after achieving complete response with chemo-immunotherapy per KEYNOTE-826?
We don't know the true impact of local treatment or the durability of CR from chemo IO response. In situations like this, I have sometimes done brachy alone to treat the primary site for local control and prevent future symptomatology.
How would you approach adjuvant radiation therapy for a young adult woman with recurrent myxopapillary ependymoma?
Extraneural spread of a myxopapillary ependymoma is exceptionally rare. In this case, I would strongly favor adjuvant local radiotherapy to the postoperative sites, assuming they have not previously received prohibitive radiation doses (especially the pre-coccygeal site). The situation is different ...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
Would you consider a third course of radiation in a patient with a WHO 3 astrocytoma who has previously received a fractionated course followed by fSRS many years later?
After a long interval such as 10 years, some recovery of normal brain tolerance is believed to occur, although the degree of recovery is not precisely known. Many radiation oncologists assume partial recovery of approximately 50-70% of prior tolerance when estimating reirradiation safety, but this i...
What V5 dose constraint best correlates with late lung toxicity following definitive chemo-radiation for lung cancer?
In any radiation plan, improving conformity depends upon spreading the “low dose bath†or the V5. For years, there has been a lot of theoretical concern about spreading the low dose base and a number of retrospective analyses suggesting that the low dose bath might have some impact for the defin...
What is your preferred radiotherapy regimen for palliative treatment of cutaneous T cell lymphoma?
Cutaneous T-cell lymphomas (CTCLs) comprise numerous distinct entities in the WHO classification of hematologic malignancies. The most common CTCL is mycosis fungoides (MF) followed by primary cutaneous anaplastic large cell lymphoma. As with most hematologic malignancies, both diseases are particul...
For gross hematuria from a primary bladder tumor, what palliative radiation regimen would you recommend?
I found that 36 Gy/6 Fx delivered weekly is a great option for palliation.This has been used in curative system, as well, but I find it to be particularly helpful in elderly patients or those with travel issues. There is a phase 2 study in patients who are medically inoperable and the local control ...
Would you offer additional radiation in a young patient with T4N1 rectal cancer, s/p TNT and pelvic exenteration with a positive deep margin without gross disease seen on post-operative imaging?
This is a very difficult decision. Although somewhat arbitrary, it is considered desirable to have at least a 6-month interval, preferably a year, before considering re-irradiation. For a patient who had surgery following TNT, the interval since the first course of radiation is presumably only a few...
What GTV to CTV margin do you typically use for the primary lesion in anal cancer?
With the availability of modern on-board imaging, I use a smaller margin, typically a 1.5 to 1.8 cm expansion from what I contour as the anal canal, which includes the GTVp. I've found that this margin is adequate and can help reduce skin toxicity and dose to the genitals.