Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you recommend prophylactic orthopaedic stablization of a long bone metastasis perceived to have high risk of pathologic fracture?
The risk of pathologic fracture is dependent on how much weight bearing the site of metastasis bears (lower extremities higher risk than upper extremities), size of the metastasis (>= 2.5 cm in the cortex of the femur is high risk), whether the lesion is lytic versus blastic (lytic is worse), and pe...
Is there a volume or size criteria where you feel that standard doses for palliative radiation (8Gy/1fx-30Gy/10fx) are not effective?
At the risk of running off the mathematical rails, I thought about this question from a completely non-clinical viewpoint (from a clinical viewpoint, yes, I would probably use a bit more than 30/10 for a big 10 cm mass). Here are a few assumptions. First, the D-sub-zero (D0) for many tumor systems h...
How do you manage sarcomas of the hand or the feet?
This is a very difficult question. Please see my answer to the previous Mednet question: How would you optimize patient set-up and planning for the post-operative treatment of a distal lower extremity sarcoma? for general information on how I approach set-up for these patients.Hand and feet sarcomas...
When utilizing hypofractionated radiotherapy in the post mastectomy setting, are the nodal regions dose painted to a different dose or the same dose as the chest wall/reconstructed breast?
Our usual dose to the reconstructed breast/chest wall is 45 Gy in 18 fractions, requiring at least 95% of the PTV to receive 100% of the prescribed dose. The prescribed dose to internal mammary nodes (when treated) is the same, with a slightly lower acceptable dose (95% of the PTV receiving 95% of t...
Would you consider 5-fraction whole breast RT for a patient with multiple positive margins following lumpectomy for whom reexcision is not possible?
It’s not the whole-breast fractionation that matters, as 5 or 15 fractions are adequate doses for whole breast, but I would definitely add a boost equivalent to a dose of 16 Gy to the surgical bed.
In what situations in gynecologic radiation would you consider using a vaginal marker for CT simulation and daily treatment?
In my opinion, the most important indication for using a marker is in the situation of cervical or uterine cancers that extend distally into the vagina. The vaginal extent of disease is almost never well-visualized on CT or even MRI. Direct visualization and palpation, with seed marker placement, re...
How do you interpret nodes with minimal increased uptake on PSMA PET in prostate cancer?
This question is relatively similar to another recent question on indeterminate PSMA PET (#26360), where I provided a longer answer in a bit more detail. The summary is that this essentially relies upon your clinical judgement, and there is no definitive algorithmic way to determine the true nature ...
What are your top takeaways in Medical Oncology from SABCS 2025?
lidERA trial. This is the first phase III trial showing an advantage for an oral SERD giredestrant over standard endocrine adjuvant therapy in early breast cancer. Treatment with giredestrant led to a 30% reduction in the risk of invasive disease recurrence over standard endocrine therapy at the fir...
Under what circumstances would you start steroids for a patient with a new brain tumor prior to biopsy or resection?
In my opinion, for all brain tumors regardless of type, steroids should be initiated if it is felt that perilesional edema is the predominant cause of presenting symptoms or the amount of perilesional edema is large enough to cause midline or trans-tentorial shift, even if asymptomatic. Otherwise, f...
Is central lumpectomy always required for Paget's disease of the breast?
Radiation without surgery for patients with Paget's disease was abandoned decades ago, but perhaps unfairly. Several groups in the pioneering era of breast-conserving therapy tried this approach. Local failure rates with whole-breast irradiation with or without a boost in patients with disease limit...