Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a patient with acute development of radiation changes around the target while undergoing a course of lung SBRT?
The answer to this question is dependent on the dose/fractionation of lung SBRT being employed. For example, at our institution, we preferentially use single fractions for peripheral lesions and for fractionated central dose schedules such as 50 Gy in 5 fractions, we do not gap the treatments but tr...
How would you treat a patient with oligometastatic disease to the lung for whom SBRT/SABR is not feasible?
I am not sure what this means exactly, as far as not technically feasible. Very old machine? Lack of dosi/physics support? If you can do VMAT with image guidance at your machine, you can probably do SBRT/SRS. You just need to have physics do their thing. In America, we use a billing definition to c...
How do you treat a rectoprostatic fistula after prostate SBRT?
This is a difficult problem to manage, regardless of whether it occurs after SBRT or any other type of prostate radiation. It will require close cooperation between multiple specialists. Early involvement of a gastroenterologist and a colorectal surgeon is imperative as this is likely to require a d...
How do you manage brain mets involving the cavernous sinus?
Metastatic disease to cavernous sinus region is rare, but has been described in the literature. Assuming the patient is a candidate for SRS, can consider delivering, in 5 fractions, 30 Gy as feasible to GTV, while underdosing PTV margin to a dose of 25 Gy while keeping optics structures within appro...
How would you approach a patient with high-grade gastric lymphoma who achieved a CR following chemotherapy?
About half of all lymphomas arising in the stomach are high-grade non-Hodgkin lymphomas, primarily DLBCL. Initial treatment would consist of chemoimmunotherapy (R-CHOP). The number of cycles of systemic therapy, and whether consolidation RT is appropriate, would depend upon stage, extent of disease ...
Do you account for prior EBRT when treating with 177Lu-PSMA-617?
No, we do not account for it. In the future, with a better understanding and implementation of Dosimetry, it may be important, particularly as LuPSMA moves into earlier lines of care.Patients receiving this therapy are heavily pretreated often with RT in the VISION study. We use palliative radiation...
Would you offer EBRT for an unresectable and growing substernal goiter compressing the trachea, esophagus, and aorta that has been refractory to RAI?
I know of no data demonstrating that XRT will affect any local control for this benign process; this patient requires a surgical consultation.
In a breast cancer patient treated with neoadjuvant endocrine therapy, how would the presence of a lymph node micrometastasis influence your recommendations regarding radiation therapy?
Data free zone but that being said, since the likelihood of PCR is low (not like triple negative or HER2 negative), I usually don’t necessarily add RNI. For BCT, treat with tangent including level 1 and 2 nodes. For mastectomy, look at other risk factors (pre and post ET) to see if would offer PMRT.
Would you treat comprehensive nodes in an ER+/PR+/HER2+ breast cancer with an initial biopsied node showing atypia and then pCR (0/2 SLN) on lumpectomy?
These are challenging cases. I will ask the pathologist if there is any sign of treatment effect in the nodes. If there is, I will treat comprehensively.If no treatment effect, I will discuss the pros/cons with the patient. I do offer and consider given that MA20 showed modest increases in toxicity ...
Would you offer post-lumpectomy RT in a young adult with DCIS, who received bilateral whole lung radiation for Wilms Tumor as a child?
I think it is difficult to make an absolute pronouncement as to whether one would or would not offer radiation therapy in this particular circumstance. How young is the individual? What dose did they receive for the bilateral whole lung radiation? How long ago was the radiation delivered? What is th...