Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you include treatment of the entire staple line for an NSCLC staple line recurrence?
I was taught years ago that the whole staple line has been to be considered at risk since it is anatomically distorted and "nobody" knows exactly where the foci of microscopic disease may be hiding. In the scenario where there is a true focus then of recurrent disease on the staple line, I have ther...
Is there a high risk CTV volume for epiglottis primary?
The primary and positive nodal stations plus 5 mm. Important to recall that you can’t see superficial mucosal tumor on imaging.
Would you recommend radiation to the prostate after prior transurethral ultrasound ablation (TULSA PRO)?
My answer assumes that the patient tolerated transurethral ultrasound ablation well and does not have significant complications from the procedure. I would consider this patient to be analogous to one with a history of a TURP or prior treatment with cryotherapy. In general, these patients are exclud...
Do you offer ultra-hypofractionated 5-fraction whole breast RT after oncoplastic rearrangement?
We do routinely as long as can meet dose homogeneity criteria.
Would you offer RT for a low-grade esophageal GIST if the patient was not a surgical candidate?
From my standpoint in sarcoma/connective tissue malignancies, I warmly agree with Dr. @Dr. First Last. I actually have had a patient in nearly this same scenario... I treated him for a localized soft tissue sarcoma, and on staging he was incidentally found to have an unrelated esophageal GIST, which...
Do you ever initiate on degarelix and then switch to leuprolide for patients with prostate cancer and cardiac risk factors receiving ADT?
I do not believe that there is a major differential in cardiotoxicity between LHRH antagonists and agonists. The key issue is metabolic syndrome associated with long-term androgen deprivation. Randomized trials have not shown convincing evidence of a difference in cardiotoxicity between agonists and...
Do you offer adjuvant radiotherapy for completely resected breast fibromatosis after lumpectomy?
I would not, following the principle of managing fibromatosis at other sites.
Are there studies looking at Ra-223 and SBRT for oligometastatic disease in the setting of mCRPC?
Yes, quite a few including one from UCLA- NCT05496959
Would you manage a subtotally resected pilocytic astrocytoma with deleted CDKN2A differently than one with intact CDKN2A?
Among brain tumors, CDKN2A loss has the greatest clinical implications in histologically low and intermediate grade gliomas. In IDH-mutant astrocytomas, the presence of homozygous deletion of CDKN2A is associated with poor outcome. Usually, pilocytic astrocytomas (grade 1) have a very good prognosis...
Would you offer ultrahypofractionated 5 fraction breast radiation to a patient with lupus?
Favor partial breast over whole breast if feasible.APBI or IMPORT LOW volume and FAST-Forward dose of 26 in 5.