Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach ADT use in a salvage RT patient with biochemical recurrence whose Decipher score is very high but PAM50 subtype is non-luminal B?
Yes, especially if PSA is more than 0.5 ng/mL.
What is the key to becoming an outstanding radiation oncologist?
I am not sure that my life experience qualifies me to answer such a big question but in attempting to give you my opinion, I have drawn upon the behaviors and values of my mentors and others in the field who made a significant difference in the lives of their patients, colleagues, and students. If I...
What is the longest acceptable interval between hysterectomy and vaginal cuff brachytherapy for high/intermediate risk endometrial cancer in the age of COVID-19?
We usually start no later than 9 weeks post hysterectomy. It is based on this retrospective study.
Are there any volumetric constraints associated with toxicity in the dose range that is moderately above prescription (i.e. 30-35 Gy range), when planning hippocampal-sparing whole brain radiation?
This is an important question worth some discussion. As the question mentions, clinical trials of HA-WBRT have permitted a hot spot of 133% of the prescription dose of 30 Gy (or 40 Gy) to D2% of the whole-brain parenchyma as an acceptable protocol variation. Importantly, none of these trials have de...
What resection margins are required for DCIS with a component of invasive disease?
The SSO-ASTRO-ASCO guidelines of 2016 on margin status for patients with tumors that are pure DCIS or predominantly DCIS requiring a minimum of 2 mm for those receiving RT were based on a meta-analysis of (mostly older) published studies, not individual patient data. Three much more recent studies f...
Given the 10-year outcomes of UK FAST-Forward presented at ESTRO, how have you expanded the use of ultra-hypofractionation in your practice?
We offer 5 fractions to all early-stage breast cancer patients. If technically suitable, the preferred option is APBI; otherwise, FAST-Forward 26 Gy in 5, ensuring dose homogeneity as specified in the protocol.
Do you constrain the dose to the oropharynx, parotids, or oral cavity when planning HA-WBRT?
On NRG CC001, there was no inter-arm difference in reported adverse events of oral mucositis (N=6 on conventional WBRT arm vs. N=4 on HA-WBRT arm), oral pain (N=3 on conventional WBRT arm vs. N=1 on HA-WBRT arm ), or dry mouth (N=19 on conventional WBRT arm vs. N=18 on HA-WBRT arm) (Brown et al., PM...
When treating node positive anal squamous cell carcinoma, does your lymph node boost include only gross disease with margin or do you boost the entire nodal region?
First of all, I should note that, for purposes of RTOG 0529, there are eight nodal regions: mesorectal, presacral, right and left inguinal, R+L external iliac, and R + L internal iliac. So a patient with a clinically involved right inguinal node would only receive boost treatment on the right. The c...
In light of the recent results of FAST-Forward, particularly the 5-year results of the nodal substudy, would you consider offering ultra-hypofractionation for WBI + RNI?
While I think that the data on moderate hypofractionation is mature enough (40 Gy in 15 fractions or 4256 in 16 fractions) to consider moderate hypofractionation in many patients undergoing regional nodal radiation or PMRT, I personally am not yet comfortable routinely offering Fast Forward to this ...
How do you manage an implanted insulin pump or continuous glucose monitoring device during radiation?
We do not have an official written policy yet, but honestly, we probably should develop one, since these devices are becoming more prevalent. For CGMs, we ask the patient to place the device far from the treatment site while under treatment and to verify function with finger stick glucose measuremen...