Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What treatment technique do you recommend for maximum hearing preservation when treating a vestibular schwannoma: fractionated radiosurgery (25 Gy in 5 fractions) or single fraction radiosurgery?
HI I was asked to respond to this very interesting question, we have tried both 5Gyx5 and SRS for these cases, and we moved our practice from SRS to hypofractionated a number of years ago. I have been equally disappointed with the outcomes in terms of hearing preservation with both approaches, parti...
How does implant breast reconstruction/augmentation at the time of lumpectomy affect your adjuvant radiotherapy approach?
I believe the question may be regarding cosmetic augmentation at the time of lumpectomy, which is not something we see standardly at our institution. I agree that conventional or hypofractionated RT based on the PMRT data would be reasonable in that setting. In patients with breast augmentation prio...
Is there any role for post chemotherapy (R CHOP x 6) radiation therapy after a splenectomy for a stage IE diffuse large B-cell lymphoma involving only the spleen?
Quite an interesting presentation in terms of extranodal site and age. I would say no for consolidative RT here. For Lugano PET CR after R-CHOPx6, the added benefit of ISRT in a young patient is low and counterbalanced by a real long term 2nd malignacy risk. Other than bulky >7.5cm sites, 'special' ...
Assuming that a lipoma is causing significant morbidity and there is not a surgical option, would you treat it with radiation therapy?
Here are my thoughts: Without surprise, the data regarding the use of radiation therapy for the treatment of lipomas is sparse as lipomas are typically easily resectable and do not develop in places where they cause morbidity. However, I think you can make the argument for offering radiotherapy as w...
Do you prescribe steroids prior to each fraction of lung SBRT?
We do not use prophylactic steroids prior to treating patients with lung SBRT. With over a decade of experience with close to 1500 patients, we have never identified a routine clinical scenario where these have been required. Of note, however, when we have participated in clinical trials where the p...
What is your technique for MRI to CT fusion for intracranial SRS planning?
Acurrate fusion has become a real concern with single isocenter VMAT and mulitple small peripheral mets, as there are many ROIs. Todd, the abstract you cited for fusion on the pediatric protocol: 1.8 mm average error with 2 mm standard deviation (https://www.ncbi.nlm.nih.gov/pubmed/20381270) Present...
What dose and planning techniques would you use for LINAC based SRS of a craniopharyngioma with reasonable distance from critical optics and brainstem OARs?
I would recommend a single fraction of 12 Gy, taking into consideration the optical structures. Our early experience using GammaKnife in 14 patients treated for craniopharyngioma ranged from 11 to 20 Gy with a median of 14 Gy in a single fraction; Amendola et al Pediatric Blood and Cancer August 200...
How would you manage an endometrial cancer with no (or minimal) myometrial invasion and only a very small focus of disease in a pelvic node?
Eventhough stage IIIC endometrial cancer is the most common sub-stage among locally advanced patients, patients with node positive disease have routinely been combined with other stages for clinical trial purposes (including high risk early stage disease, stage IV, and recurrent disease). This not o...
When would you consider local ablative therapy (e.g. SBRT, surgery) for patients with oligometastatic non small cell lung cancer on immunotherapy?
Definitely would treat this exactly as I do for EGFR or ALK-targeted therapy. If the patient is doing well, and most sites of disease continue to be controlled but one is progressing I would consider local ablative therapy. That being said, I just had a patient doing well with a CR on ipi-nivo for ...
What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?
The bottom line is there is no magic bullet that works well. I start Glutamine a week before and throughout the duration of the treatment. It seems to delay the onset. I use custom made mouth pieces to reduce dental scatter if possible--that will reduce mucositis I start with over the counter analg...