Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach a patient with ATM mutation with prostate cancer?
This is a good guide for a radiation oncologist suggesting no contraindication to RT, with a possible small increase in second cancer (most data based on breast cancer).
Would you consider APBI in a patient who received neoadjuvant chemotherapy?
I do not consider APBI in patients who have received neoadjuvant chemotherapy. While I am aware that some do, I do have concern regarding encompassing volume at risk. With more patients receiving neoadjuvant endocrine therapy, this is also an area where we don't have great data. I have not tradition...
Do you ever boost equivocal pelvic lymph nodes in a patient with low PSA who will get salvage XRT?
The question has two spins to it. Do we do it? Probably yes, as it's easy to do without much morbidity, if treating the pelvis to begin with. Does it help? We don’t know, as reactive nodes are not uncommon in the pelvis. Once PSMA scans are available, one would have a better estimation of nodal dise...
Do you use an age limit cutoff for SBRT in lung cancer?
We do not use an age-based cut-off when considering safety/eligibility for SBRT, instead treating patients with appropriate overall health and condition, and lesions which are sufficient to warrant treatment. Our own institutional experience (Videtic et al., Pract Radia Oncol 2017) describes the ou...
What fractionation would you recommend in a patient with prostate cancer and a bulbar urethral stricture?
Hopefully, the bulbar urethra would be outside PTV volume, so fractionation would not change based on that. The patient would need the stricture addressed before any treatment to help with symptomatology.
Would you consider telomeropathies as an absolute contraindication to radiation therapy?
No, but it's very relevant to discuss the implications of RT when there is an indication for radiotherapy when consenting a patient.Many telomeropathies are subclinical/under-diagnosed due to variability in the clinical phenotype (Walsh et al., Clin Cancer Res 2017), but there are clear data both fr...
What do you consider a curative radiation dose for a sarcoma?
This is a difficult predicament. We would certainly try to re-resect if at all possible; if not, a consideration could always be made for an amputation, but we try to avoid this if at all possible. Other options during the time of resection are consideration for brachytherapy. We would also discuss ...
Is it acceptable to deliver ablative hypofractionated radiation therapy for unresectable intrahepatic cholangiocarcoma in conjunction with concurrent checkpoint inhibitor?
There are safety data from MGH with single agent checkpoint inhibition (from @Dr. First Last) that demonstrate the combination is safe. The only concern I would have would be if you were starting both at the same time and the TAAs started to rise. You would not be able to discern toxicity from the d...
How would you approach a new solitary sternal metastasis for a triple positive breast cancer 1 year after hypofractionated breast radiation?
These are increasingly common scenarios in our practices. The first step would be systemic staging to ensure that this is a solitary metastatic site or there is limited metastatic disease. I would have the patient evaluated by medical oncology to discuss systemic therapy options for this triple posi...
How do you manage symptomatic brain metastases from small cell lung cancer?
I would like to know pertinent information including the following: age of the patient, performance status, prior whole brain radiotherapy (WBRT) or prophylactic cranial irradiation (PCI) history, systemic therapy the patient received or is receiving, size of this suspected symptomatic brain metasta...