Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What would you recommend for a patient with bilateral conjunctival MALT (without systemic disease)?
While technically this patient is stage IVAE (>1 extranodal site is categorized as stage IV), these patients do as well as those with unilateral conjunctival MALT NHL. Bilaterality is not unusual in this disease. This is a situation where definitive treatment (24 Gy in 12) is appropriate for stage I...
Would you consider elective nodal irradiation when treating a solitary mediastinal node recurrence after chemo RT for non- small cell adenocarcinoma?
Rarely do I consider elective nodal irradiation after solitary mediastinal recurrence, especially after previous chemoRT. The morbidity of treating large volumes after previous chemoRT remains significant. After mediastinal relapse, patients still are at the highest risk for distant failure. Therefo...
Given the final results of GOG258, what regimen do you recommend use to treat Stage III endometrial cancer?
Full dose chemotherapy is important in stage III+ patients to prevent risk of distant failure. However, patients in GOG 258 who received chemotherapy alone had an unacceptably high risk of developing locoregional recurrence (27% 5-year incidence combining vaginal + pelvic/para-aortic). Despite conc...
How do you minimize urethral dose when doing LDR prostate seed brachytherapy with small glands (<20 cc)?
These cases can be challenging, especially when you approach the 10 to 15cc range. I’ve approached them using back to back sources in the peripheral needles, and loading the central needles in a manner to minimize the 150 isodose line overlap with the urethra. One should pay special attention at the...
How do you decide which local consolidative therapy to offer for a single lung metastasis in a patient with metastatic colorectal cancer?
SBRT, then more chemotherapy.
How much volume reduction do you typically observe following radiotherapy for a meningioma?
Assuming this is for indolent grade I meningiomas, retrospective studies show that the range for volume reduction following fractionated radiotherapy or stereotactic radiosurgery can be anywhere from 13% to 61%. Also, the interval time to volume reduction may be anywhere from 6 months to years. In s...
What constraints do you use for the external beam portion of radiation when combined with brachytherapy boost?
Simply “scale” down your constraints for the bladder, rectum, and fem heads for a 44fx regimen down to 25. It’s a simple mathematical calculation. No need to convert for small bowel or penile bulb, as these tissues should not get a dose from the implant. The scaled constraints allow for some flexibi...
If a patient who had mastectomy and implant reconstruction for T1N0 breast cancer developed a new lesion years later in the axillary tail, should the implant be removed and the chest wall treated or would you consider APBI to spare the implant?
First we need to confirm the CW recurrence or new primary. The presence of DCIS in axillary twill would favor new primary. Either way, even if the entire chest wall needed to be treated, the implant need not be removed. The patient would need to be counseled about the effects on cosmetic outcome.
How do you sequence TTFields into your salvage therapy plan for patients with recurrent glioblastoma?
For those patients who have not had TTF previously (we do not offer it in the salvage setting if they had received it initially), we evaluate for clinical trial eligibility first, and offer this option (unless for clinical reasons resection is urgently indicated). If a clinical trial is available, a...
What screening criteria do you use to give patients IV contrast for the CT sim?
This is an extremely frustrating and commonly encountered scenario in radiation oncology clinic (and the diagnostic CT suite). What is most frustrating is how stubbornly the dogma of contrast-induced nephropathy has persisted, and the vast amount of needlessly wasted resources spent worrying about i...