Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you utilize SRS/SBRT in a patient with oligometastatic disease from adenocarcinoma of the lung who is unable to receive standard chemotherapy?
Ultimately, any attempt at promoting a durable progression free survival period for patients with metastatic NSCLC, even if oligometastatic, usually would require the ability of the patient to tolerate some systemic therapy. Nearly all of the studies that have incorporated local therapies in the for...
In patients with 3 or more positive sentinel lymph nodes who get a SLNB only, do you advocate for an ALND even if you are planning to treat their regional nodes regardless?
Although they were underrepresented in AMAROS study, in reality a scenerio like this is so uncommon that it would be hard to have any prospective study. We do not push for dissection if pre surgery imaging and clinical exam was consistent with NO disease and plan these patients with comprehensive no...
Do you preferentially use 10MV over 6MV in CNS IMRT treatments to prevent alopecia?
This seems like wishful thinking. I would be very surprised if there were any clinical data in this regard. Alopecia will be far more related to other factors such as nearness of the target volume to the skin surface and, with IMRT and other treatments that use multiple angled beams, the "obliquity ...
What is your preferred approach to a patient with newly diagnosed primary mediastinal B-cell lymphoma in the upfront setting?
I recommend DA-R-EPOCH in almost all patients. For the rare patients with stage 3-4 disease, I consider RCHOPx4 followed by ICE (unpublished data from Memorial Sloan Kettering).
When treating patients with whole breast RT with a sequential boost, what technique to you use for the boost when treating patients prone for whole breast irradiation?
At NYU, we treat the vast majority of our patients in the prone position and use a number of techniques for the boost. We most commonly treat with mini-tangents in the prone position. We'll often use a combination of 6 and 16MV to help spare the breast lateral or medial to the involved tumor bed. We...
When treating patients with hypofractionated radiation to the breast in 16 fractions do you typically treat 4 or 5 days a week?
We treat 5 days a week which was the standard in the Whelan randomized trial that compared this fractionation scheme to conventional fractionation (https://www.ncbi.nlm.nih.gov/pubmed/20147717). In the START B trial, 15 fractions (total dose 40 Gy) were given also in 5 consecutive days (https://www....
Would you offer prostate radiotherapy to a patient with lymphocytic colitis which is being managed with budesonide?
In general, I look for reasons to avoid irradiating the colorectum in patients with chronic inflammatory conditions affecting this organ. These are patients for whom I generally recommend surgery for prostate cancer. If they end up needing adjuvant or salvage radiation, the dose and volume of irradi...
What radiation dose is appropriate for patients receiving induction chemoradiation prior to surgery for superior sulcus tumors?
RTOG 0229 demonstrated the safety and efficacy of increasing the radiation dose to 61.2 Gy in the trimodality setting. Therefore, current standard concurrent chemoradiation therapy uses 61.2 Gy, which is safe with or without surgical resection, with improved mediastinal nodal clearance rate (63%). 4...
Do you electively cover the celiac axis in a patient with node negative middle third to distal, and GEJ esophageal carcinoma?
We do treat celiac axis nodes for distal esophagus and GE junction tumors along with the gastrohepatic nodal region for patients treated with a curative intent.
Would you offer salvage RT to a patient with adverse features after prostatectomy if his post-operative PSA was highly elevated (for example >10 ng/mL), but his metastatic work-up was negative?
The benefit in a patient like this with salvage RT is very limited if at all and I would not offer RT. This persistent elevation of more than 10 after surgery is from occut metastatic disease and local RT would not help with the outcome. Ga68 PSMA PET if available may pick up some of the disease tha...