Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach CNS directed therapy in a patient with Parkinson's disease?
I have in the past encountered very few patients with Parkinson’s disease who have required CNS radiotherapy for tumors. The main thing is if the patient has any head tremors at rest (which is rare), extra care for good head immobilization, and perhaps additional target PTV, would then need to be co...
Do you have preferred regimens for young patients (<30 y/o) with early stage DLBCL?
For patients with early-stage, non-bulky disease, 3 cycles of R-CHOP + ISRT (30 Gy) provides excellent outcomes. This strategy is particularly attractive if the site(s) of disease requiring irradiation would engender a very low risk of late effects from RT (e.g., an inguinal lymph node). In the rand...
What is the largest non-spine bone metastasis you would be willing to treat with SBRT?
The size or volume per se is not a limiting factor for SBRT. Doses to OAR (parallel and serial organs) are the most important factor. I have treated large bone metastases with ablative radiotherapy (SBRT or hypofractionated IGRT) without issues.
For breast cancer patients s/p IORT with pathologic features indicating that follow-up whole breast radiation is needed, is the current standard of care to use conventional fractionation or are there data to support hypofractionation?
I have used 40 Gy in 15 fraction, as the equivalent dose is less than 50 Gy in 25 fraction, and thus we don’t expect a significant difference in outcome.
Is there a role for definitive radiation in a patient with vaginal melanoma who is not a surgical candidate?
Yes, for local control and preventing symptomatology. I use a combination of EBRT and brachy, with the type of brachy based on the response to EBRT. Some patients do have a complete response, although the risk of distant metastasis is very high.
Do you treat regional nodes for node negative (by SLN) patients with early stage breast cancer in a medial location?
High grade. Triple neg.
How would you manage a high risk SCC of the scalp that has wound healing issues after Mohs surgery?
Refer the patient to plastic surgeon for wound repair. Indicate that the cancer is high risk for recurrence and warrants adjuvant RT (sooner rather than later), and that a vascularized reconstruction is preferable for that reason. In our experience, 60 Gy in 30 fractions is effective to prevent loca...
How would you treat a T4 rectal cancer invading the uterus that is causing rectal and vaginal bleeding?
In this T4b locally advanced rectal cancer, I would recommend neoadjuvant chemoradiation (RT dose 45 Gy to the pelvis +/- boost to 54 Gy to the gross tumor), followed by surgery (including a hysterectomy). The bleeding should stop in the first 2 weeks of neoadjuvant therapy. You do, however, have to...
How do you sequence ADT relative to radiation for a low volume M1 prostate cancer?
Start with radiotherapy, carry on hormone therapy for up to two years.
What radiation approach would you use for a young patient with locally advanced Her2+ breast cancer, with complete metabolic response after neoadjuvant chemotherapy who refuses surgery?
We are in a data free zone here, and all effort should be made to encourage the patient to undergo surgery, and not compromise on survival.