Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would obtaining a breast MRI for patients going to be treated with APBI be beneficial?
The published outcome data for APBI does not suggest routine use of MRI as part of the work up and have shown a low local recurrence rate. A recent randomised published study by GEC estro also did'nt mandate MRI as part of work up and showed low recurrence rate and equivalent outcome to whole breast...
What is your approach to left sided PMRT in patients with on-going cardiac issues (ie. cardiomyopathy, heart failure, coronary heart disease)?
In this circumstance, like for any medical intervention, we need to carefully weigh the risks and benefits of treatment. The likelihood of radiotherapy-induced cardiac injury appears to dependent on two variables: 1) Cardiac dose. This is variably defined - I think mean heart dose may be the best su...
When would you recommend definitive radiation or surgery + PORT for a resectable skin cancer metastatic to the parotid?
Surgery and postop RT unless medically inoperable or unsuitable for a gross total resection. The control rate for RT alone is a lot lower.
Is a fluciclovine (Axumin) PET scan an adequate imaging modality for prostate cancer re-staging after a biochemical failure?
Fluciclovine (Axumin) [FACBC] PET scan was FDA approved in May 2016 for recurrent prostate cancer – FDA approval was based on high accuracy of PET uptake when correlating with biopsy. As with any diagnostic imaging test, Axumin has higher diagnostic yield with increasing PSA. While Axumin can assist...
Would you treat the supraclavicular field and IMNs for a patient with cT3N0 breast cancer who has a complete response following neoadjuvant chemotherapy?
For T3N0 who have upfront mastectomy and the pathological nodal status is negative, if I offer PMRT, I usually treat chest wall only without treating the nodal region, as data suggests almost all locoregional recurrences are in the chest wall.For clinical T3N0 who get neoadjuvant chemo and have resi...
Should definitive radiotherapy and ADT be offered to patients with PSA > 100 who have no evidence of metastatic disease?
PSA > 10,000 ng/mL would be a valid indication not to proceed . . . Otherwise, I would not let a case be ruled by labs in the absence of definitive radiological or pathological evidence of incurability . . .
What heart dose constraint should be used when treating locally advanced NSCLC?
I use V50 <25%, then again I was the senior author on one of those 3 papers, so I'm a bit biased! To be clear, though, I think the punchline here is that the metric being use is fundamentally less important than just using a metric that is more stringent than the historic constraints. It is well est...
Would you recommend adjuvant radiation for a completely resected large well differentiated sarcoma (i.e. liposarcoma) involving the retropharyngeal area and mediastinum?
Here's my take on this. Intrathoracic sarcomas are rare tumors, and there isn't much data to rely on for treatment recommendations. The only study I'm aware of is this retrospective review from University of Washington published in Journal of Radiation Oncology in June 2016 And the only low-grade pa...
Do you utilize a V80Gy dose constraint for the rectum for definitive dose-escalated RT of the prostate?
I generally treat to 78 Gy in 2 Gy fractions or to 79 Gy in 1.8-2 Gy fractions, so I'm very concerned about hot spots and where they are located. I try hard to keep the rectal Dmax less than 80 Gy. That's not always possible. I will accept max doses up to about 82.5 Gy if the volume is not more than...
How long after WBRT would you wait to give SRS to a recurrent brain metastasis?
Practically speaking, radiation necrosis from whole brain radiation is very unusual. So most progression post whole brain radiation would be considered tumor recurrence and may be best treated with SRS. With newer immunotherapeutics, however, pseudoprogresion may be seen and needs to be considered. ...