Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For a patient with HER2+ breast cancer with progressive but asymptomatic disease in the brain, would you hold off on WBRT to do a trial of tucatinib, or proceed with WBRT then tucatinib?
The trial allowed both treated and untreated brain mets, and showed response rate and improved survival. If the patient is not a candidate for SRS, it’s reasonable to watch brain lesions with serial MRIs.
How would you plan adjuvant radiation for a N+ breast cancer in a patient who had received prior lung SBRT near the treatment field?
I have had cases with SBRT and started off with CT planning for the breast; I have used DIBH. I then fuse previous dose plan to current plant. For these cases, I have not always used VMAT. If this is lung SBRT, typically OAR constraints are not drastically affected for breast RT with respect to ipsi...
How do you manage a supratentorial anaplastic ependymoma in an adult?
Unfortunately, given the rarity of this tumor, we'll never know for sure. However, I do treat those patients similar to high grade gliomas in adults. Having said that, in high grade gliomas, I use smaller margins 0.5-1 cm (GTV --> CTV) and I think it would be appropriate in this setting as well. A b...
What small bowel dose constraints do you utilize when treating resected pancreatic cancer?
Questioning the normal tissue tolerance in the setting of a resected pancreatic cancer raises a number of issues. To answer the question of which of the listed dose constraints I use, the answer is neither. There has been a general trend in the field to use less conventional radiation therapy postop...
What duration of ADT do you recommend for a patient with otherwise favorable intermediate risk features but a mpMRI showing gross extracapsular extension?
All of the responses so far are reasonable to me. I am assuming the patient is Gleason 3+4 with PSA <10 ng/mL. I am wary of applying a new technology to categorize patients to older trials (i.e., T3 on mpMRI and assuming that is the same as clinical T3 prior to MRI). That said, I can't call a patien...
Do you alter your management of ADT in a patient with high-risk prostate cancer who is a transwoman receiving estradiol hormone therapy?
We published a case report several years regarding a transwoman who developed prostate cancer who had been on estradiol therapy in JAMA. She presented with a PSA of over 100. She continued on her estradiol therapy. We did not use LHRH since she had a bilateral orchiectomy for her transition. She was...
In what clinical scenarios would you cover the optic nerves when treating with whole brain radiotherapy?
In general, for brain metastases (assuming not a candidate for hippocampal avoidance) standard whole brain radiotherapy fields would cover part of the optic nerves. If whole brain is for primary CNS lymphoma, I would cover the orbits which would encompass the entire optic nerves. If whole brain RT i...
Is it safe for a patient to breastfeed during their course of EBRT?
Not aware of any concerns. In our pregnancy-associated breast cancer patients, I encourage women to breastfeed on the side I am not treating as long as med onc has cleared them. We work with pediatricians to ensure that the infant is reaching normal weight/growth milestones, but may need to suppleme...
Would you consider salvage radiation in a recurrent prostate cancer with a positive pelvic node and high inguinal node on PET/Axumin, but negative inguinal biopsy?
I would treat this patient as having oligometastatic disease to the nodes, similar to the more common scenario of finding 1-3 para-aortic nodes beyond a typical pelvic XRT field.Assuming no prior radiation to these sites, I would try a VMAT plan as long as skin constraints are met for the inguinal s...
Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?
As per FAQ’s posted by ASTRO: There is no reason to do so at this time. Be vigilant re: hand hygiene and wiping down any equipment that touches the patient (stethoscope, etc.). Additionally, any equipment that touches mucosa/secretions of the patient must be sterilized (rhinolaryngoscope, etc.). For...