Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When practicing cervical brachytherapy with both intracavitary and interstitial approaches, do you obtain an MRI with each fraction of HDR BT?
Yes, we do obtain an MRI for every fraction. We are fortunate enough to have an MRI near the brachytherapy suite. Sometimes, though, if the patient has a small tumor and we're performing only intracavitary brachytherapy, then we do not do an MRI for every fraction, but typically do that for the firs...
When should surgical tumor resection be considered in patients with a low-grade glioma?
In adults with low-grade gliomas, there is substantial evidence suggesting that aggressive, early surgical resection improves outcomes and survival (Jakola et al., PMID 23099483). Historically, this has been particularly true for tumors that carry an IDH mutation or 1p/19q codeletion. This survival ...
In a patient with metastatic pancreatic cancer with diffuse liver metastases, would you consider whole-liver radiation to lower bilirubin so that they are daraxonrasib eligible?
I think it is an interesting idea. However, I would not expect the TB to decline after RT. Stable, maybe, but not a decline. If TB is rising, that is from parenchymal destruction, and radiation will not reverse it. If obstructive, only stenting would make sense.
When do you consider neoadjuvant radiation for inflammatory breast cancer?
I utilize neoadjuvant radiation only in the setting of a patient inoperable following neoadjuvant chemotherapy. I have used xeloda + radiation in such situations as well.
What is the role of neoadjuvant breast radiation in patients with triple negative breast cancer progressing on AC-T?
There is no standard treatment in this setting. If a patient is not a candidate for clinical trial, we have been doing RT with concurrent carboplatinum or xeloda with the hope of making the disease operable. In our experience, response is mixed with a set of patient making it to operable stage.
Is there a rationale for treating medically inoperable stage I-III breast cancer patients with RT alone?
We treated stage III patients with "radical radiotherapy" with or without chemotherapy when I was a resident in the early 1980s, since they were considered SURGICALLY inoperable then. However, very high doses were needed (75-80 Gy to the primary using external beam followed by interstitial implants)...
When treating locally advanced breast cancer preoperatively that is progressing on neoadjuvant chemotherapy, to what doses do you treat the gross disease, breast, and regional nodes?
I typically treat 50 Gy to large fields including the entire breast and regional nodes and take any gross disease to 60-66 Gy. I also discuss with my medical oncologist the possibility of concurrent xeloda as well.
Given the final publication of NSABP B-51, for which patients meeting trial eligibility would you still recommend regional nodal irradiation?
The very first thing that should occur before one makes a decision about what they are going to do is to understand how the trial was designed and who was actually accrued to it. The first point is that B51 was a superiority and not a non-inferiority trial. A very related point to that is that they ...
What RT dose/fractionation would you use to treat an unresectable grade 3 solitary fibrous tumor abutting the optic nerve and chiasm?
Generally, I would consider treating an unresectable grade 3 solitary fibrous tumor to up to 59.4/60 Gy, or possibly higher. The location of this tumor makes it difficult to treat entirely using this dose while respecting the optic nerve/chiasm constraints. How is the patient's vision? If intact, op...
How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?
Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).Initial as...