Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Will patients who receive radiation to a large mediastinal nodal field have an increased susceptibility to COVID-19?
While the actual infection of COVID-19 has more to do with hygiene, social distancing, and prevention such as drugs or vaccines, the susceptibility for the patient to develop symptomatic progression of COVID-19, once infected, has a strong theoretical possibility. The factors that impact severe lymp...
Are there select patients with rectal cancer where radiation field size reduction might be feasible?
Yes, however, how to select which patients could have a field size reduction is unknown. Such a field size reduction is probably even more acceptable in the era of total neoadjuvant therapy, however, this cannot be considered standard of care given the absence of trials evaluating such novel approac...
Would you use upfront atezo/bev in a patient with HCC and untreated hepatitis?
Yes. I would not have concerns. For HBV, I would start treatment before or simultaneously. Studies have varied by protocol about the HBV viral load being under 500 or 100 but it is not clear this matters. There have not been flairs reported. In regards to HCV, again, not an issue for me.
Is there a correlation between rectal cancer stage and dose response to radiotherapy?
Possibly. While some compelling data from Appelt et al. in 2013 reflected there may be a correlation between RT dose and rectal tumor response (Appelt et al., PMID 22763027), an extensive number of prospective trials examining the influence of boost doses of RT on pathologic response have produced m...
For a patient s/p laryngectomy with positive margins, would you start radiotherapy 6 weeks s/p surgery if there is a delay in concurrent chemotherapy?
The question is a bit challenging without understanding the reason why the patient is suited for XRT but not chemo. My best guesses would be a concurrent infection or PS issues, possibly due to deconditioning after a hard surgery.However, part of the decision would involve when it is anticipated tha...
How do you manage a cytology-negative pleural effusion that develops after lung RT?
I think most times you can just watch them as long as they are stable and not symptomatic. I see them not infrequently after RT, especially lung SBRT, and find they often find a size they feel comfortable with and don't change much over time. I wonder about their physiology... my impression is there...
Do you counsel patients differently about the risk of radiation induced malignancy when you are treating a proximal joint (hip) vs a distal joint (elbow) for benign conditions such as OA?
The mentality for this must change from radiation oncologist thinking to radiation medicine thinking. There have been no documented cases of malignancy from LDRT treatment of OA. Those who worry about the spine reference old studies giving 20 Gy in 5 fx with an open field pre-linac era. This is not ...
For patients with locally advanced rectal cancer who desire organ preservation and can tolerate fluoropyrimidine but not oxaliplatin, what is the appropriate treatment approach?
For patients with locally advanced rectal cancer who desire organ preservation and cannot tolerate oxaliplatin, the appropriate treatment approach would be neoadjuvant, long-course radiotherapy combined with fluoropyrimidine-based chemotherapy. After neoadjuvant treatment, patients are ev...
What is the best IGRT strategy in treating the prostate bed (adjuvant or salvage): Daily anatomy KV images vs. fiducial seed kv images vs. CBCTs?
For our post-prostatectomy men, we use daily kV and line up to surgical clips if available (contouring out a clip each quadrant of the prostate bed if possible) with a PTV expansion of 5 mm. If clips are not present, then we use CBCT to evaluate soft tissue alignment and use a slightly larger PTV of...
What is the current paradigm for breast cancer diagnosed with isolated metastases prior to initial treatment?
Surgery of the primary did not significantly improve overall survival in which patients were randomly allocated to receive systemic therapy alone or (for responding patients) to systemic therapy followed by primary tumor resection in the trial conducted by ECOG-ACRIN (Khan et al., PMID 34995128), at...