Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer PMRT for a small focus of invasive disease in a background of extensive DCIS?
I am assuming node negative with SNLN. Normally I don’t treat but would like to know the grade of cancer along with how many margins are close (how close defined in mm) and if close disease focal or diffused at the margin. If all the above are unfavorable then would consider chest wall RT.
When planning concurrent chemoradiation for locally advanced NSCLC, do you consider prescribing primary tumor disease to a lower isodose line, such as 75%, if OAR constraints for standard prescribing are met?
For stage III NSCLC, we routinely deliver 60 Gy to PTV with SIB 66 Gy to GTV in 30 fractions using IMRT with concurrent chemotherapy. Some clinical data indicated that primary tumors might need higher dose in order to achieve optimal local control. Therefore, it could be reasonable to consider an ev...
Is there a role for prostate cancer lesion boost with EBRT in the setting of combination EBRT+ brachytherapy?
I’m not sure if I see a significant rationale for employing an EBRT focal boost in addition to a whole-gland brachytherapy boost. If one were to want to deliver more dose with this treatment paradigm, it seems more dosimetrically efficient to boost the area with brachytherapy. Prior work has also re...
What techniques and dose constraints do you utilize to limit lower extremity neuropathy when providing post op radiation following soft tissue sarcoma resection?
What is your preferred skin surface maximum dose constraint for skin brachytherapy?
In a recently published study of electronic skin surface brachytherapy, we used a technique that delivered approximately 8.7 Gy per fraction to skin surface (125% of the prescribed dose of 42 Gy in 6 fractions of 7 Gy delivered to 3 mm depth from skin surface). This publication demonstrates the acut...
How would you treat a periungual squamous cell carcinoma of the thumb?
Digit-sparing margin-negative excision if possible. If amputation is the only surgical option, then consider definitive RT, reserving surgery for salvage.
Would you offer adjuvant radiotherapy to a young patient with microinvasive lobular carcinoma (< 1 mm) in a background of LCIS?
I would favor RT as part of BCS but would also like to know the LCIS type (pleomorphic or not) to better quantify the risk of IBTR.
What dose constraint do you use for the spinal cord and/or cauda equina for a spinal meningioma?
Presumably WHO 1. 50.4/28 fractions. Good control. Low risk of injury.
How do you time PET/CT surveillance and COVID boosters?
I have not changed the timing of PET surveillance imaging around vaccinations but 1) is a frequent question from patients, and 2) I have seen a fair amount of false positive FDG avid axillary adenopathy post-vaccination. Think this tends to be too unpredictable in the duration of these imaging findi...
What approach do you take to determine dose constraints for SBRT reirradiation of the head and neck?
There is likely no "safe" dose when delivering full-dose SBRT overlapping tissue that previously received 40-70 Gy. The best you can do is make sure the patient understands the risks, that this strategy fits their goals of care, that you've considered all alternatives, and that you approach planning...