Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
If you must start adjuvant radiation more than 6-8 weeks postoperatively, whether due to complications or healing, do you accelerate treatment in any way?
This is a controversial area with varied opinions. Here are a few of my takeaways: For delayed patients especially with high risk pathology, I usually re-image (preferably with PET) before making a recommendation. This is based on multiple series (Shintani et al., PMID 17889447, Kibe et al., PMID 3...
How do you treat localized esophageal carcinoma in patients who are unwilling or unable to undergo chemotherapy or surgery?
This is a question that comes up occasionally in clinic. My viewpoint is generally based on the prospective data that we have. Of course, the RTOG 85-01 study showed 0% long-term OS with definitive RT vs CRT. Additionally, the Intergroup 0123 study showed no evidence of improvement with higher dose...
What dose constraints do you use for the left anterior descending artery (LAD) for breast radiation?
We published in the Red Journal in 2022 a single-institution analysis of LAD/heart dosimetry and association with cardiac events in 375 patients with a history of left-sided breast or chest wall irradiation: Zureick et al., PMID 35483540LAD Dmean EQD2 of 2.8 Gy and LAD Dmax EQD2 of 6.7 Gy were found...
Is there any role for differential cardiac substructure dose tolerances when treating with radiation for breast cancer?
There is growing literature on the role of defining cardiac substructures and potential dosimetric constraints for these substructures as an improved methodology for cardiac DVH assessment, as compared to mean heart dose (Jacob et al., PMID 30732640).However, at this time, we do not have robust long...
Which GI cancer patients do you use oral contrast in staging CT scans?
We do not use oral contrast for most of our patients and only offer oral contrast CT scans for patients we are concerned about perforation.
Is is okay to offer SBRT for central lung tumors in direct contact with the esophagus?
My short answer is: probably not, if you are considering standard regimens like 10Gy x 5. The risk of fistula appears to be significant if you expose the esophagus to full prescription dose. My group described two patients receiving lung SBRT who developed significant esophageal complications (fistu...
Are there any situations where you would not offer SBRT for an oligometastatic bone lesion from breast cancer?
Many things are learned "the hard way." I have zapped a LOT of bone mets from prostate, breast, and other sites in the oligometastatic setting. One patient had a solitary met from Lung CA n his R humerus. It involved 2/3 of the length and had substantial soft tissue extension. It was 2008'ish and I ...
Would you recommend PMRT for T2N0(i+) breast cancer?
In this situation, I do not normally offer PMRT as long as margins are negative. There are some that would consider in this scenario if triple negative but I don’t usually.
What goes into patient selection for 50 Gy rather than 36 Gy as pre-operative dosing for localized myxoid liposarcoma based on the DOREMY trial?
I take these case by case. For localized, biopsy- and translocation-confirmed myxoid LPS (liposarcoma) of the extremity/superficial trunk, I offer 36 Gy when a local recurrence would remain readily resectable at acceptable morbidity. I stick with 50 Gy when the tumor broadly abuts bone or a neurovas...
How do you approach treating oligometastatic endometrial cancer in a patient with good performance status and no local recurrence at the primary site?
For metachronous OM would follow the SBRT approach/principle similar to other primary cancers after systemic treatment.