Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a healthy patient >65 years of age with glioblastoma multiforme, what is the recommendation for temozolomide when given concurrently with adjuvant radiation therapy?
Glioblastoma (GBM) is primarily a disease of older adults. The median age of diagnosis is around 60. Many of these patients present with a host of co-morbidities that impact their performance status (PS), overlapping with GBM-related complications. There are multiple scenarios to consider when evalu...
Is it safe to deliver SBRT with concurrent immunotherapy to head and neck sites of progressive metastatic disease?
Yes, have done this many times. Constraints are hard to come by. If it is reirradiation, RTOG 3507 provides guidance, if it is never radiated you have even more leeway.
For early stage TNBC without nodal disease, is a prone breast setup contraindicated due to concerns of suboptimal chest wall coverage?
There is no data to suggest that we need to cover chest wall for early stage TNBC after BCS.
How would you approach patients who have undergone nipple sparing mastectomies with close or positive margins at the nipple areola complex?
We have treated a few patients with adjuvant RT with the same principal of positive margin and literature suggests that nipple areolar complex tolerates RT well with no excessive risk of complex failure.
For persistent PSA elevation after prostatectomy, would you recommend salvage radiation if pathologically negative nodes, but regional and non-regional lymphadenopathy on PSMA PET?
While based on classical staging methods, it appears that he would fulfill the criteria for salvage RT with a persistent PSA, it sounds like this patient has M1a disease by advanced imaging (possibly at presentation). I think that it is very unlikely that he would gain any meaningful benefit from ad...
How would you treat a patient with an keratoacanthoma of the right nasal ala?
In my experience, these patients are treated surgically and radiation does not play a role.
How would you approach treatment of the brain in a patient with ES-SCLC found to have CSF cytology positive for malignant cells but negative MRI of the brain?
A patient with extensive small cell lung cancer that is found to have + CSF cytology cannot be cured. The therapeutic focus should be symptom control and prolonged comfort. The treatment for ED-SCLC is systemic therapy. Commonly, that does not cross blood brain barrier. The question of whether to tr...
What planning techniques and constraints do you use when treating H&N cancer with VMAT as it relates to arcs that sweep through shoulders that ride high?
For VMAT planning, we do try to avoid beams from angles where the shoulders can get in the way. In Eclipse, this can be relatively easily accomplished by turning on avoidance sectors during optimization. If this function is not available, one can choose to split the arcs, which will be more work for...
Would you ever utilize quad shot specifically for a large SNUC?
The Quad Shot is palliative, while even in advanced SNUC definitive chemo-RT provides a chance for about 50% LR control at 2 years and long-term cure in 22% of patients. This is based on our results in 19 patients, almost all of whom had Kadish stage C or AJCC T4. In our experience, a surgical attem...
How would you approach treatment in a patient with well controlled ulcerative colitis planned for salvage RT?
This is a great question. In patients with well controlled UC or any inflammatory bowel disease, I typically will have no concerns treating them, which is supported by recent data/manuscripts.First and foremost, I have a discussion with the patient's GI doctor to make sure any medications or intrica...