Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you make any modifications to your treatment plan for older patients undergoing prostate SBRT?
At UCLA, we do not make treatment modifications of prescription dose or change our dose constraints for OAR in our elderly patients (> 75 y.o.) undergoing prostate SBRT. We have not noticed a difference in toxicity in older patients. Admittedly, this has not been studied in our cohort of patients in...
How would you treat very locally aggressive rectal cancer extending into muscle and causing internal iliac tumor thrombus, in a patient who is not a surgical candidate?
I would treat with chemoradiation, 50.4 Gy/28 fx using a 3D conformal technique and standard rectal cancer volumes. The lumbosacral plexus prevents doses higher than 60 Gy, and in general there not much evidence of dose response between 50Gy and 60Gy.
Is multifocal disease an indication for RT in an elderly patient with early stage and otherwise favorable breast cancer?
IBTR for upfront unifocal and multifocal disease is similar and would not change recommendations for me if all other factors were favorable.
What radiation regimen do you use to palliate bulky melanoma metastases involving the oral cavity?
I like this 9 Gy x 3 melanoma regimen by Dr. Jens Overgaard from Denmark:https://www.ncbi.nlm.nih.gov/pubmed/4044346It's an oldie from 1985, but uses roughly the same regimen (9.5 Gy x 3) subsequently found to be the trigger of an abscopal response in a patient progressing on ipilimumab, as reported...
Is PORT recommended for incidentally found N2+ NSCLC after lobectomy for oligoprogressive metastatic NSCLC?
I would say it should probably be used very selectively in this population. We routinely use PORT for stage 3 patients who have incidentally discovered N2 nodes, but I try to keep in mind that that evidence supporting its use is not strong, even in the curative setting. There's a consistent LC bene...
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.
How would you approach a young patient with metastatic rectal cancer and a painful local recurrence who underwent chemoRT to 50.4 Gy two years ago and declined surgery?
The answer depends on the anatomy. I would re-irradiate to the GTV only with margin 39Gy in 26fx BID. With a 2 year interval, I would judge that this is not resistant disease and that should buy some more time, but obviously not definitive. I would tell him the only curative option would be to follo...
Does the presence of interstitial lung disease affect your recommendation for BCT vs mastectomy for early stage breast cancer?
I would not use the diagnosis of interstitial lung disease to impact my recommendation for BCT vs. mastectomy. For low risk cases, one can omit RT. In other early stage cases, APBI can be used to reduce lung dose. For locally advanced cases, if the patient can tolerate DIBH can be used or tighter ta...
Do you regularly utilize antiemetic or GI prophylaxis when treating abdominal sites with SBRT?
I regularly use antiemetics for patients treated with SBRT for pancreatic cancer and selectively for patients with liver metastases or hepatocellular cancer. I am agnostic about the antiemetic choice, often the patient has either ondansetron or prochloperazine already; and I ask them to take it 30-6...
What would be your recommended target volume for a high-risk head and neck cutaneous squamous cell carcinoma with microscopic (not clinical) perineural invasion and negative sentinel node biopsy?
That is a good question. Our pathologist takes perineural involvement one level further by describing the nerve involvement as either being small or large nerves. If small cutaneous nerves are involved I make certain that my margins are at least 1.5 cm beyond the clinical tumor margin. If a large ne...