Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you routinely recommend consolidative radiation to bulky site(s) in the setting of advanced stage DLBCL?
How radiation therapy (RT) should be incorporated into the management of patients with advanced DLBCL continues to be investigated. In the setting of widespread, non-bulky disease, when a complete response is achieved with systemic therapy, I don't recommend consolidation RT. Though controversial, I...
In what situations do you order an Oncotype DX DCIS score for a patient with DCIS?
This is an excellent question. I suspect there will be many takes on this question since there is considerable controversy about omitting RT for DCIS in general. Here's what I think we know.Let's review the clinical data from the Oncotype Dx DCIS Score.1) Solin L et al JNCI 2013: A subset of the pat...
Should SBRT for bone metastasis be delivered daily, or every other day?
Canadian/Australian study gave 24 Gy in 2 fractions on consecutive days and no excessive toxicity was noted.I schedule them daily, but if there is a patient convenience issue, QOD is reasonable.It is very interesting, however - there is conflicting data on the efficacy of QD vs QOD for SBRT for lung...
How do you explain the risks and benefits of palliative radiation therapy to patients with fungating breast masses?
The value of palliative RT in these patients is to dry up oozing and bleeding and RT is very effective in achieving that goal. I have had success in these patients almost all the time and my usual dose is 30-39 Gy in 10-13 fractions.This study gives a prospective dataset for fractionation and pallia...
What is your approach to consolidation for localized small cell bladder cancer after neoadjuvant cisplatin and etoposide?
There is limited data with regard to the best management of these patients. Most data is retrospective and has an inherent bias. That being said, there seems to be a benefit for surgical resection after NAC (Patel et al., 24036236), with RT a consideration if surgery is not an option. In a small ser...
Given the new ASCO guidelines on SNB in early stage breast cancer, how does the omission of SNB in patients aged 50-70 impact your adjuvant radiation recommendations?
If the patient is otherwise a good candidate for APBI (age > 50, pT1 tumor, ER+, HER2 negative, Recurrence score low and intending to take endocrine therapy) that was clinically node negative and ultrasound axilla negative, I feel completely comfortable treating with APBI post lumpectomy with negati...
Would you offer a third course of palliative radiation after two courses of 8 Gy in 1 fx?
There are rarely definitive answers to questions like these, but I’ll do my best to detail some of my thoughts on how I would approach this situation, since I was asked to fill this request. I would usually have a conversation with a patient about the risks and benefits, and then utilize a shared, i...
Do you ever treat cervical nodes above the standard supraclavicular field for breast cancer patients?
In the setting of biopsy-proven supraclavicular or cervical nodal disease, I do extend my fields cranially to include these nodes. I typically include the entire neck level based on head and neck contouring atlases and extend the cranial border at least 1 cm superior to the highest node. If nodes ar...
What factors do you take into account when deciding the length of adjuvant temozolamide in GBM?
The field is evolving from 12 cycles to 6 for IDH-wildtype GBM in recent years, on the basis of some retrospective studies and notably the prospective Spanish study GEINO 14-01 - there does not seem to be much OS benefit, and there are also toxicity concerns (myelosuppression, hypermutation). Extens...
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
Randomized studies have consistently demonstrated that combined modality therapy is superior to chemotherapy alone in regards to progression-free survival in early-stage Hodgkin lymphoma. The magnitude of the benefit varies across studies, but a relative risk reduction of ~50% can be expected which ...