Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever use molecular assays such as Oncotype to modify your recommendations for withholding RT after lumpectomy in invasive breast cancer?
This is part of the ongoing IDEA study. At present, we don't use Oncotype DX information for withholding RT for invasive breast cancer after lumpectomy.
How would you manage a patient with a rapidly growing, clinically localized breast cancer who is medically inoperable?
I would consider chemoRT for a medically inoperable breast cancer. Here is a prospective trial (https://www.ncbi.nlm.nih.gov/pubmed/20878462) that used paclitaxel and radiation to treat locally advanced breast cancer in the pre-op setting. I use this in the palliative setting for medically inoperabl...
Do you consider idiopathic pulmonary fibrosis a contraindication to lung SBRT?
The number of IPF patients treated at our institution has been relatively small, at less than 5%. When they have presented with medically inoperable early lung cancer, we have discussed the risk and benefits of lung SBRT with a focus on lung toxicity that may be more prevalent in this clinical scena...
Should adjuvant radiation be given for an atypical (WHO II) meningioma of the thoracic spine after gross total resection?
Overall data are thin in this arena, in large part due to the relative scarcity of the disease. We recently published a bi-institutional experience (Wash U/U of Utah) of the largest cases series to date of 102 patients with spinal atypical meningioma (AM) underoing resection (Simpson I-IV) (Sun et a...
Would it be appropriate to treat an adult with a pure germinoma at 1.8 Gy/ fraction instead of the pediatric dose of 1.5 Gy/ fx when treating with radiation alone to the whole ventricle (with cone down to primary)?
We have utilized 1.8Gy per fraction as part of an institutional protocol for CNS germinomas since the 1990s with excellent results (Buckner J JCO 1999). Although the protocol was designed to examine the safety of focal radiotherapy in the setting of CR to induction chemotherapy, this protocol also i...
When do you offer consolidation chemotherapy for patients receiving chemoradiation for locally advanced NSCLC?
I rarely use consolidation therapy. When I do, it is usually because of lapses in or missed chemoRT treatments. We have two randomized studies that show no benefit to consolidation therapy.
How would you manage a patient with prostate cancer who has a history of total colectomy with primary anastomosis and is not a surgical candidate?
We favor brachytherapy alone in these patients. One patient we treated recently with history of IBD and J pouch after total colectomy, we tried space OAR which was difficult because of surgical scarring and the space craeted was not as optimal as patients without previous prior surgeries. However, w...
Do you have a methodical procedure for checking treatment plans before approving?
When I was a resident, an attending taught me a methodical plan for approving plans which I still teach my residents. There's nothing magical at all about it, but somehow when there are four easy steps, it's easier to follow: 1. Review the plan in axial imaging from top to bottom reviewing coverage ...
Do you ever withhold adjuvant RT after BCS in older women with stage I triple positive/Luminal-Her2 subtype breast cancers?
If they receive herceptin-based chemotherapy, then local regional recurrence rates are similar to luminal A disease (excellent review on this subject by Wendy Woodward during her talk at ASTRO in 2016- accessible on virtual meeting). So by that logic, you could consider it in someone who has receive...
Do you ever withhold PCI for elderly patients with limited stage SCLC?
In my opinion, the findings by Takahashi et al, Lancet 2017 regarding the lack of survival benefit of PCI as compared to MRI observation in patients with extensive SCLC has re-opened the question of the survival benefit of PCI in limited SCLC in the modern imaging era. Hopefully, a phase III study o...