Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What activity restrictions do you counsel patients on after radiosurgery for arteriovenous malformations, given the continued risk of hemorrhage until nidus obliteration?
Prior to radiosurgery for an arteriovenous malformation, I counsel patients that the risk of hemorrhage is not immediately eliminated by treatment and may persist until the nidus is completely obliterated, which can take several years. Therefore, posttreatment follow-up and clinical surveillance rem...
Have the 10-year results from UK FAST-Forward impacted your practice with regard to patient selection?
I would consider our practice at Mayo as early adopters of ultra-hypofractionation for breast, largely driven by similar institutional trials for shorter courses and the patients we care for. As a result, we have pretty routinely offered 26 Gy/5 fraction whole breast RT since the 5-year follow-up wa...
When in the treatment of OA do you think it is optimal to offer LDRT?
Evidence reality check: Two well-conducted sham-controlled RCTs (hand and knee OA) were negative for clinically meaningful benefit at their primary endpoints. (Minten et al., PMID 30231990, Mahler et al., PMID 30366945). ArthroRad (multicenter randomized, single-blinded) compared standard-dose vs ve...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
Would you offer adjuvant radiotherapy for a malignant fibromyxoid tumor of soft tissue with margin < 1 cm on re-excision?
Malignant ossifying fibromyxoid tumors are very rare and from a pathologic perspective, often get lumped under the tumors of intermediate malignant potential and of uncertain differentiation category. The expectation that the histologically malignant fibromyxoid tumors behave malignant, and thus I w...
Is morphea, cutaneous scleroderma, with no organ involvement a contraindication for radiation in early stage breast cancer as part of breast conservation therapy?
I am not sure anyone can answer this question with a solid yes or no answer. The information we have about limited scleroderma and radiotherapy is for, lack of a better term, limited. We can draw from some experiences to guide the thought process. In one large series of patients from two scleroderm...
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
What is your approach to TNT sequencing for locally advanced rectal primaries with low volume metastatic disease to liver?
This is a very common clinical scenario for which I'm not aware of a single correct answer. I assume by "low volume" metastatic disease to the liver the question implies potentially curable through some combination of liver-directed therapies. The only part of the sequencing about which I am fairly ...
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 PMRT considered the standard of care in women with 1-3 positive axillary lymph nodes?
I come to this question with a somewhat different stance than we have traditionally thought. To me, the following things seem clear:1) In our modern randomized trials of PMRT (British Columbia and Danish 82b and c) there was no difference in the OS advantage of RT based on # of positive nodes (1-3 v...