Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What techniques do you typically use for a photon breast boost?
Depends on the location of the cavity and depth, and breast anatomy. Mini tangents work well but can have a lot of doses beyond boost volumes. I sometimes will use a 3 field approach with a lightly waited anterior electron/photon field depending on the depth of the cavity.
What is the maximum electron energy you would consider using for a breast lumpectomy boost?
I don’t go higher than 12 MeV (normalized typically to 80-85%) and usually am more in the 9 MeV range nowadays if using pure electrons. I have moved to doing most lumpectomy boosts with photons as we can be pretty conformal and more homogeneous (although sometimes we end up treating more breast tiss...
Do you ever treat a recurrent breast cancer with RNI alone rather than chest wall and RNI?
As this is a de novo case and not a recurrence, it would be reasonable to treat the nodes and leave the chest wall alone given the small size, absence of LVI, and adequate margins.
What is your recommendation for patients who are on weight loss medications like GLP-1-based therapies while receiving chemoradiation for head and neck cancer?
I recommend immediate discontinuation of GLP-1-based therapies. Increased risk of nausea/vomiting and weight loss certainly aren't side effects we need during head and neck chemorads. Additionally, there is concern that these agents, even outside of cancer patients, contribute to sarcopenia, which h...
Would you offer re-irradiation for an upper GI bleed secondary to a necrotic, intraluminal gastric Merkel cell metastasis previously treated with 50 Gy in 25 fractions roughly one year ago?
Although we prefer to avoid re-irradiation, it needs to be compared to the other options for stopping bleeding from a necrotic tumor. If there is an appropriate artery to embolize, for example, that may be an appropriate approach. In many cases, though, there will not be good alternatives to radiati...
Would you offer lung SBRT in a patient with Pulmonary Langerhans Cell Histiocytosis (PLCH)?
Langerhans cell histiocytosis (LCH) is a clonal proliferation of Langerhans cells (dendritic cells), part of the mononuclear-phagocytic system. Some patients present with unifocal disease, often in bone. A variety of treatments are acceptable for unifocal disease, including radiation therapy. Very l...
What urethral dose constraints would you use off-trial for reirradiating the prostate using SBRT?
The short answer to this question is that there is no evidence-based answer. Below is a review for anyone interested. Background: The recognition of local recurrence as a pattern of failure seems to be growing, perhaps in part due to the increased utilization of advanced imaging (as previously discu...
Would you consider APBI in a patient who meets all criteria but has high-risk genomic testing and is not receiving chemotherapy?
I would proceed with APBI 30 in 5 as it has a boost dose built in to account for a high genomic score.
Do you change your definitive therapy approach for a patient with locally advanced central NSCLC with obstruction of a mainstream bronchus and subsequent collapse of the lung?
Treating a patient with a collapsed lung with definitive CRT can be difficult. Those patients typically have a higher risk of infection and often have increases in the rates of symptomatic pneumonitis. My first priority is to try to get the lung open before initiating definitive treatment. Often, in...
In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?
As simple as this question seems to be on the surface, it is actually a very difficult clinical scenario to opine with certainty, primarily because of a lack of data. So, let us address this with each option in mind, weighing the pros and cons: Observation: We do know that in resected patients, radi...