Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does an esophageal stent impact your radiation treatment plan for a patient with non-metastatic GE junction adenocarcinoma?
While the presence of a stent might not directly affect my radiation dose and volumes, due to numerous other considerations, it would certainly affect my overall treatment plan. I highly encourage avoiding a stent in the setting of radiation due to toxicity concerns in addition to the complications ...
What radiation treatment volume would you include in chemoradiation given for perihilar lymph node recurrence after surgical resection and mediastinal lymph node dissection for NSCLC?
I typically ask for a PET-CT, MRI brain, and comprehensive EBUS. If isolated to the hilar LN, I would just cover that region and not any elective nodes.
Would involved site radiation therapy be recommended in a patient with POEMS syndrome whose myelopathy symptoms worsened after one cycle of CyBorD?
I would swiftly treat this patient with a common schedule, for instance, 5 x 4 Gy. I do not see any risk of concurrent rituximab.
Would you utilize splenic radiation for patients with non-myeloid malignancy and splenomegaly in the setting of platelet sequestration, which is limiting cytotoxic systemic therapy options?
I am not sure if I understand your question correctly. However, if splenomegaly is not associated with a) lymphoma infiltration of the spleen or b) ectopic hematopoiesis in the spleen, then spleen irradiation will not help.
Would you consider omitting concurrent chemoradiation for a patient with stage III EGFR-mutant NSCLC and initiating treatment with osimertinib instead?
No. Osimertinib alone is a palliative treatment with limited durability, which is not appropriate as first-line therapy for a patient who is interested in and eligible for definitive treatment. While the outcomes of the control arm of chemoradiotherapy without osimertinib in the LAURA trial were cer...
In a patient who underwent cryoablation for early NSCLC, is there a role for giving preemptive further local therapy?
Hi @Dr. First Last. It's a good question and speaks to some of the ambiguity in the space we work. The interventional physicians are giving a therapy they present as being equivalent to other established options (like surgery or SBRT) but it doesn't have the same depth of research and history. It de...
What daily/weekly imaging (MV/KV/CBCT) do you use when treating regional nodes in breast cancer?
We primarily treat regional nodes using 3DCRT. As such, we check weekly ports of all films (tangents, SCV +/- PAB). We have concurrent surface imaging which is used daily. When using IMRT (uncommon in my practice, < 10% of cases requiring RNI), I use CBCT with alignment to chest wall (IMNs).
Is there any evidence that demonstrates an increase in rectal or bladder toxicity with protons for prostate cancer compared to IMRT?
This is a great and controversial question. I recently contributed to a review that tried to summarize the current studies to date looking at this question. As you know, there are no completed phase 3 trials comparing protons to photons in this space, and we eagerly await results from the PARTIQoL t...
How would you manage a slowly progressive benign brain tumor located near critical structures such as the optic chiasm/brainstem?
This is a very common occurrence, except that frequently we don't have histology. For example, meningiomas in the region of the cavernous sinus are frequently diagnosed by imaging criteria. In any event, I recommend radiation therapy for slowly growing asymptomatic, presumed benign tumors that are n...
In patients getting concurrent chemo-immunotherapy for locally advanced cervix cancer, would you hold immunotherapy during the 2.5-3 weeks of brachytherapy?
Pembro is continued throughout the course of treatment. Initially, every 3 weeks for 5 cycles with concurrent chemo RT plus brachy and then every 6 weeks for 15.