Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a biopsy proven isolated internal mammary node recurrence one year after a mastectomy and chemotherapy?
These are very challenging cases and multiple options exist. In the situation of no radiation therapy previously, I would treat comprehensively (after systemic staging to rule out metastatic disease), including chest wall, SCV, and IM nodes. I would consider boosting the involved IM nodes with a mar...
How would you approach a patient with simultaneously diagnosed stage IVA SCC of the head and neck and limited stage small cell lung cancer (neither is symptomatic)?
The treatment option with ES-SCLC may be slightly more clear since the patient has incurable disease and will succumb to their lung disease. I would start chemotherapy and keep an eye on the H&N cancer and offer palliation as needed including a QUAD shot (depending on the size of the primary and sym...
For liver metastases, what criteria do you use to decide between SBRT vs Y90?
The treatment of choice is ablative SBRT as long as liver constraints can be met. Kras/p53 wildtype CRC mets can be controled with 70%+ certainty at 5 years with 100Ghy BED, but Kras/p53 mut CRC mets are resistant (Hong, et al, JNCI,2017). For this reason, I use a BED of 150Gy but a dose that overco...
What is your approach to re-irradiation of the brachial plexus?
The best data thus far is the reference you already alluded to. I always outline the brachial plexus during the initial course of RT and do the same in cases of reirradiation where the neck is being irradiated. Overall, for reirradiation cases for recurrence in the primary location there is little r...
What sites for SBRT are thought to be more immunogenic for antigen presentation when combined with immunotherapy?
I am aware of only one prospective trial structured to approach this question to some extent. It was from Jim Welsh's team at MDAH and was presented at ASTRO this year.http://www.redjournal.org/article/S0360-3016(17)33877-4/abstractThere was a hint that sequential ipilimumab followed by RT to lung l...
Would irreversible elctroporation (IRE) performed at the time of Whipple affect your plans or dose for radiation in the setting of adjuvant treatment for pancreatic adenocarcinoma?
IRE is an ablative modality that is more selective for tumor than thermal ablation. There are at least 2 high volume centers (Louisville and Miami) that have reported interesting long term survival in locally advanced pancreatic cancer. During their learning curve, there were multiple grade 5 compli...
Would you treat your left sided breast cancer patients with DIBH (deep inspiration breath hold) and IMRT when the target includes regional lymph nodes?
We do treat with tangential beam RT where match between tangent and supraclav is Same half beam block with no issue with matching
Would you offer prostate specific PET imaging (e.g. Axumin or PSMA PET) in a post-RT prostate cancer patient that has a rising PSA that has not yet met failure criteria?
Maitre et al., PMID 35189154 This study shows a high pick up rate with PSA not meeting failure criteria and many of them had focal relapses which are potentially salvageable.
Are you routinely offering spine separation surgery followed by SBRT/SRS for spine oligometastatic lesions abutting the cord?
I do not offer separation surgery. I view it as an extension of decompressive surgery by surgically creating a gap that may allow the radiosurgery to the epidural lesion. It sounds good but, in fact, this adds a significant surgical invasiveness with anesthesia in order to perform the non-invasive r...
Have the presented results of GOG 249 at ASTRO 2017 changed management of early stage uterine papillary serous cancers from chemo +VC/EBRT to pelvic RT only?
UPSC tend to fail with distant mets. Therefore chemotherapy is reasonable. Per the study results Chemo + VC/EBRT is reasonable. At times chemo is not feasible/ tolerated so we use EBRT+ Vc. I have enrolled pts on this study and noted the interesting results.