Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you counsel patients on the risk of dementia following androgen deprivation therapy for prostate cancer?
No, I generally do not counsel men about this risk. The two studies from the same investigator use a data warehouse search algorithm that may not be accurate enough to fully characterize who gets Alzheimer's disease or may not be able to correct for confounding factors that may be different between ...
What is the appropriate volume to re-irradiate in a recurrent GBM?
We need to recognize there is no standard dose fractionation regimen for re-irradiation in recurrent GBM. The volume and CTV/PTV margin are heavily depended on the dose/fraction you pick for your patients, and radiation techniques. The most commonly accepted regimen is probably 35 Gy in 10 fractions...
In a patient with brain metastasis confined to the cerebellum, would it be reasonable to treat the posterior fossa only (vs WBRT)?
If the patient has favorable prognostic factors and would like to avoid memory loss associated with WBRT, I would first consider whether the patient is eligible for stereotactic radiosurgery. If not a candidate for stereotactic radiosurgery, I would consider enrollment on eligible hippocampal avoida...
When treating an intact whole breast with hypofractionated radiation, how do you approach boost dosing in the case of a close margin?
In the Plenary session of the 2012 San Antonio Breast Cancer Symposium, Dr. John Yarnold reviewed all of the updates of the UK START and Royal Marsden HFRT trials and discussed the fact that 40 Gy in 15 fractions had become the standard for the UK's National Institute for Health Care and Excellence ...
How do you manage an acute herpes zoster infection (shingles) in a radiation therapy treatment field where the skin is getting a significant dose of RT?
Physician's awareness is crucial in Zoster infection. Systematic acyclovir and local Zovirax is usually very effective if caught early. A break in therapy is more detrimental than treating over the zoster. Perhaps one or two days break to stabilize zoster therapy at the most. Routine skin care along...
What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?
Although myeloma is radiosensitive, since it has caused metastatic epidural spinal cord compression, I will still offer 30 Gy in 10 fxs or 37.5 Gy in 15 fxs, a dose closer to a definitive dose for plasma cell tumors, in order to provide a more durable local control. See variant 2:ACR appropriateness...
Do you recommend holding a TKI when treating brain metastases with SRS/WBRT?
There are a few publications which help address this very pertinent question. The phase 3 trial of whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone versus WBRT and SRS with temozolomide or erlotinib for non-small cell lung cancer and 1 to 3 brain metastases: RTOG 0320 (...
How would you manage a localized low grade follicular lymphoma diagnosed shortly after a patient had a CR to an aggressive treatment regimen for DLBCL?
DLBCL arising from a low-grade lymphoma, typically follicular lymphoma, is relatively common. It occurs at a rate of 2-3%/year. Presumably, in this case the patient had an undiagnosed FL with early transformation. Review of the pathological specimens may shed light on this possibility. In any case, ...
Do you adjust your lung DVH constraints when treating a patient that has lobar atelectasis due to tumor obstruction?
Currently the answer is no. Obstruction is not necessarily improved after RT and greatly depends on the time the lung has been down. I currently assume that the collapsed lung is potentially functional and take it into account when determining lung volumetric constraints. This assumption may change ...
What is the best treatment management for a metaplastic carcinoma of the breast (such as adenosquamous)?
We have been treating with adjuvant RT follwing same principal as other breast cancer type as data is limited . These tend to be triple negative by IHC but there response rate with chemo is low and not like ductal triple negative cancers