Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a skull based chordoma in a pediatric patient?
How would you approach definitive chemoradiation for node positive anal cancer with a history of ulcerative colitis status-post total proctocolectomy?
If there is no recent history of active colitis I do not change anything. If there is colitis with an intact rectum, I reduce the radiation dose by 10%. The toxicity and consequences of APR are worse than the toxicity of chemoradiation.
How long would you wait after palliative short course radiation (i.e. 30Gy / 10 fractions) in metastatic NSCLC before initiation of chemo-immunotherapy?
I haven't typically waited for a specific period after short courses of palliative radiotherapy to start chemo-immunotherapy, if the patient has recovered from side effects from radiotherapy and is ready to start systemic therapy otherwise. Hopefully, data from studies and trials to better inform us...
When treating anal squamous cell carcinoma, how does your radiotherapy regimen change when there is a bleeding anal fissure?
I wouldn't delay tx. The simple non-surgical things used to try to manage an anal fissure (Metamucil, warm water soaks, and a topical cream like Anusol) also help to get a patient through the acute effects of RT. I would be very uncomfortable with any surgical attempts to manage the fissure. Cutting...
What is your bladder constraint for LDR prostate brachy?
There are typically no bladder constraints with LDR planning. The bladder itself should generally not be in the PTV. The urethra does have important planning objectives/constraints, which depend on isotope and technique used. ABS guidelines are a good place to start. Some people do have loose constr...
Would you give/omit regional nodal irradiation in low nodal burden ER- Her2+ disease s/p BCS with SLNB?
When I evaluate patients in this situation, BCS + SLN with positive node, I tend to think about the decision as to the whole breast RT+/- RNI and use AMAROS/Z011 to frame my decision making.In an ER-negative patient, I would favor RNI, extrapolating from MA20 (where patients had an ALND, and 85% 1-3...
For a patient with oligometastatic breast cancer that has completed adequate local therapy, would you consider ablating synchronous oligometastatic disease?
The prospective studies which are conducted for locoregional treatment for synchronous metastases didn't include treating metastatic disease with SABR. In practice, if we go the route of LRT in select subset, then consider SABR also, if still visible after systemic treatment.
Is there any role for differential cardiac substructure dose tolerances when treating with radiation for breast cancer?
There is growing literature on the role of defining cardiac substructures and potential dosimetric constraints for these substructures as an improved methodology for cardiac DVH assessment, as compared to mean heart dose (Jacob et al., PMID 30732640).However, at this time, we do not have robust long...
In the treatment of recurrent trigeminal neuralgia, what local therapy would you recommend after failure of medical therapy?
I will recommend surgery (microvascular decompression) only when there is a surgically fixable abnormality, such as vascular compression. In that case, microvascular decompression is more effective than SRS. Otherwise, I will offer SRS, which can be offered twice targeting a root entry zone and a mo...
Would you offer radiation alone to localized recurrence of extensive stage small cell lung cancer while on maintenance immunotherapy or would you start alternative systemic therapy?
The role of local therapy for the treatment of patients with ES SCLC has been evaluated in a number of phase 3 trials. The first trial, which was published by Jeremic et al., PMID 10561263 over 20 years ago, reported a survival advantage for adding thoracic radiation to chemotherapy compared with ch...