Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your treatment approach for a recurrent brainstem glioma?
Recurrent brainstem glioma is a very challenging situation. One could consider participating in a clinical trial if available, especially one that targets some of the known mutations in the tumor (such as histone h3, TP53, ATRX, ACVR1, and others). We have previously re-irradiated a few patients at ...
How do you manage triple negative primary squamous cell carcinoma of the breast?
Rare disease with no defined SOC but limited literature suggest poor outcomes as they don’t respond to systemic treatment like TNBC.Hennessy et al., PMID 16258085
Would you consider post-operative SBRT following long bone stabilization (i.e. femoral intramedullary nail) for radioresistant tumors?
It depends on the type of surgery done. Using proximal femur as an example, if an IM or interlocking nail is done, the nail passes straight through the tumor and contaminates the whole medullary cavity. The CTV will need to include the tumor plus the femur down to the femoral condyles. SBRT won’t be...
What dose and fractionation do you recommend for an unresectable epithelioid hemangioendothelioma of the rib?
Conventionally fractionated radiotherapy [60 Gy in 30 fx] has been described for this very rare clinical scenario, i.e., primary unresectable disease. This reference provides a good review of this disease entity and its management [Stacchiotti et al., PMID 34090171]. As a function of tumor location ...
How would you manage an adult patient status post subtotal resection of spinal osteoblastoma?
US can be helpful if performed serially. If/when there is evidence of growth, discuss ablation options with IR if feasible.
Would you consider radiotherapy for unresectable malignant pleural mesothelioma in an asymptomatic patient?
The standard of care is palliative chemotherapy + potential Ipi/Nivo now that there is that option. Radiation should be reserved for consolidation or palliation for symptomatic sites of disease or progression. Radiation should be done using hypofractionated approach, with dose per fraction exceeding...
What are your top takeaways from ASTRO 2022?
1. NRG RTOG 1005: A Phase III Trial of Hypofractionated Whole Breast Irradiation with Concurrent Boost vs. Conventional Whole Breast Irradiation Plus Sequential Boost Following Lumpectomy for High Risk Early-Stage Breast Cancer The results showed that with hypofractionation and SIB technique, 7 year...
How do you counsel NSCLC patients receiving SBRT on fatigue?
The first thing is to warn the patient and their family that fatigue is possible, and that it peaks about 2 weeks after treatment ends. I also remind them that SBRT is like surgery in that it causes some damage that requires energy to repair, so some fatigue is to be expected. Finally, I tell them t...
What dose/fractionation would you use for a patient with unresectable, ER+/PR+/HER2 negative breast cancer who declines chemotherapy and progresses locally after receiving endocrine therapy with abemaciclib?
I think there are a few approaches to this. I would first discuss with my surgeon, what makes the patient unresectable. One consideration if borderline resectable is neoadjuvant RT, I use this study as a guide though sounds like the patient may refuse capecitabine (Woodward et al., PMID 28843370).If...
Should osimertinib be held prior to yttrium 90 liver directed therapy?
While not a common scenario and thus paucity of high level of incidence, I will, in principle, hold 1-2 days before the procedure and wait until a week post procedure ensuring LFTs are within acceptable range before restarting osimertinib.