Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What high dose rectal constraints do you use when using a hypofractionated prostate regimen?
Of course the answer is different depending on which hypofractionated regimen that you use.If you are using the CHHiP regimen (60 Gy in 20 fractions) the trial investigators have updated their recommended constraints based on the observed toxicities in the trial.In a preproof online they have provid...
Under what circumstances do you consider a biopsy for a patient with a new brain lesion who is undergoing active systemic cancer treatment?
Indications for biopsy would be rare: First - if the brain lesion is dural-based and slow-growing, and the patient has excellent systemic control. Second - if the brain lesions are progressing despite standard radiation therapy. Third - if control of CNS disease is being done using CNS-penetrating t...
Do you recommend placement of a rectal spacer when delivering radiotherapy to the prostate in patients with oligometastatic prostate cancer?
No. I have had a few patients seek it out on their own, which is fine. But I tell them it is not necessary.
How do you sequence hypofractionated radiation and systemic therapy for patients with unresectable cholangiocarcinoma?
I have generally cared for patients analogously to that done in the initial NRG GI001 or ABC07 trial designs with the use of initial systemic therapy for 3-6 months followed by consolidative RT targeting a BED > 80.5, assuming a/b ratio of 10 Gy. Tao et al., PMID 26503201 In my practice, it’s most c...
Are there cases that should be referred to a center with a MR Linac for RT?
There likely are cases that would be best treated on an MR Linac, though I suspect they are relatively few and far between. The categories noted in the question stem are certainly considerations, however, I feel that only a subset of these patients would gain true advantages. MR Linac offers the pot...
How would you manage recurrent endometrial cancer limited to pelvic and inguinal nodes in a patient with no previous radiation?
If it is a delayed recurrence, we usually treat nodal regions only (going one level above involvement) with IMRT and concurrent weekly cisplatinum chemotherapy with SIB boost to node followed by possible adjuvant chemo.
How are you clinically incorporating the data presented from RT Charm at ASTRO 2024?
This is an appropriate question with the presentation of RT CHARM at ASTRO a few weeks ago. We have been utilizing hypofractionated NON-reconstruction PMRT and regional nodal breast RT for years in my practice given our large geographic catchment area. As a general rule, I feel it's always best prac...
What dose constraints do you use when palliating pelvic structures in 5-10 fractions?
Very much depends on the total dose being delivered. If doing 20 in 5 or 30 in 10, I don't believe any structures in the pelvis are at risk for substantial toxicity, for acute or late. If going higher, then utilizing SBRT/VMAT constraints for the pelvis is reasonable. Can use @Dr. First Last' method...
What constraints do you use for a non-weight bearing bone when treating a patient with sarcoma?
The only long bone that is truly not weight bearing is the fibula. (This is why ENTs can harvest fibula for mandible reconstruction and not reconstruct the fibula.) All other long bones are weight bearing under at least some circumstances. Femur and tibia are obviously WB with ambulation. However, t...
What are reasonable SBRT dose constraints for the lumbosacral plexus?
There are published dose tolerance guidelines for the sacral plexus with the AAPM TG101 report Benedict et al. Med. Phys 37(8): 4078-4101, 2010. Realize these have not been validatedOn page 4086, there is a table with suggested dose constraints for a 3 fraction regimen that include a threshold dose ...