Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When planning concurrent chemoradiation for locally advanced NSCLC, do you consider prescribing primary tumor disease to a lower isodose line, such as 75%, if OAR constraints for standard prescribing are met?
For stage III NSCLC, we routinely deliver 60 Gy to PTV with SIB 66 Gy to GTV in 30 fractions using IMRT with concurrent chemotherapy. Some clinical data indicated that primary tumors might need higher dose in order to achieve optimal local control. Therefore, it could be reasonable to consider an ev...
Is there a role for prostate cancer lesion boost with EBRT in the setting of combination EBRT+ brachytherapy?
I’m not sure if I see a significant rationale for employing an EBRT focal boost in addition to a whole-gland brachytherapy boost. If one were to want to deliver more dose with this treatment paradigm, it seems more dosimetrically efficient to boost the area with brachytherapy. Prior work has also re...
What techniques and dose constraints do you utilize to limit lower extremity neuropathy when providing post op radiation following soft tissue sarcoma resection?
How would you treat a periungual squamous cell carcinoma of the thumb?
Digit-sparing margin-negative excision if possible. If amputation is the only surgical option, then consider definitive RT, reserving surgery for salvage.
Would you offer adjuvant radiotherapy to a young patient with microinvasive lobular carcinoma (< 1 mm) in a background of LCIS?
I would favor RT as part of BCS but would also like to know the LCIS type (pleomorphic or not) to better quantify the risk of IBTR.
What dose constraint do you use for the spinal cord and/or cauda equina for a spinal meningioma?
Presumably WHO 1. 50.4/28 fractions. Good control. Low risk of injury.
How do you time PET/CT surveillance and COVID boosters?
I have not changed the timing of PET surveillance imaging around vaccinations but 1) is a frequent question from patients, and 2) I have seen a fair amount of false positive FDG avid axillary adenopathy post-vaccination. Think this tends to be too unpredictable in the duration of these imaging findi...
Do you recommend PMRT and if so, do you treat the regional nodes, in patients who are cT4N0 (non-inflammatory) treated with neoadjuvant chemotherapy who have a pCR at the time of mastectomy?
I would recommend PMRT and treat chest wall and regional node comprehensively. At present those who present with clinical stage III disease like above and have pCR we recommend PMRT. Some of them are suitable for B51 also (stage III and node positive upfront converted to node negative) and we do off...
What is your preferred palliative radiation regimen for patients with painful bone metastasis?
Because of the great work of the BM Working Group led by Hartsell et al, and the Dutch, for examples, there are ample category 1 data supporting the use of Single Fraction (800cGyx1) EBRT for "uncomplicated" bone lesions. That is, the use of 800cGy x1 unless there is: a soft tissue component, an imp...
Do you do urethrogram at time of prostate simulation?
We don't perform a urethrogam. We do MRI with a pelvic coil and fuse it with the CT scan which helps to identify the base, lateral edge and apex appropriately.