Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with esophageal cancer with lymph node involvement, would you consider treating with definitive chemo-radiation if they have a single area of retroperitoneal metastasis?
If a patient has non-regional retroperitoneal adenopathy without other distant metastasis (i.e., below the level of the celiac axis), that patient has M1 disease, and upfront definitive chemoRT would no longer be the standard of care (systemic therapy alone would be). However, I would then consider ...
What is your preferred fSRS dose/fractionation for large brain metastases?
For large intact brain metastases, my preferred fSRS dose/fractionation would be 27 Gy in 3 daily fractions. There are retrospective studies showing 1-yr local control rates of 91% using 27 Gy in 3 daily fractions vs 77% using single fraction SRS for large intact brain metastases > 2 cm (Minniti et ...
How do you manage moist desquamation when treating vulvar cancer?
My experience is largely limited to the treatment of gynecologic malignancies, with the treatment of vulvar lesions the most common reason for development of moist desquamation. The first goal, in my opinion, is to prevent development of moist desquamation as much as possible. Skin folds that are no...
How do you treat unresectable pancreatic adenocarcinoma invading into the duodenum?
No, 54Gy did not improve survival in the LAP-07 trial, so it is definitively not a definitive dose. I would give 75Gy in 25 fx (100Gy BED) with capectabine. We have published how we do this in multiple papers, but essentially a 5mm duodenal PRV is carved out of the PTV75 so that there is a gradient...
When treating adenocarinoma of the pancreas to 75 Gy in 25 fractions, what dose constraints do you use for small bowel, large bowel, and stomach?
Planning Volumes Definition Doses by Fractionation Scheme 15-Fraction 25-Fraction Microscopic Extension PTV CTV + 5mm (CTV = GTV + 1cm + CA, SMA, +/- porta hepatis, +/- splenic hilum basins) 37.5Gy/15 45Gy/25 High Dose PTV GTV + 5mm margin excluding GI PRV expan...
Would you forgo lumpectomy cavity boost for grade 1 papillary carcinoma with associated grade 1 DCIS that has been resected with good margins?
Yes, I would treat it with the same principle as luminal A breast cancer.
Would you consider breast radiation in patients with atypical ductal hyperplasia bordering on low grade DCIS?
I would have it reviewed by pathologist as along with pathological features, size and number of ducts, which is used as feature to distinguish ADH from DCIS. That being said for these low grade small volume DCIS would favor surgical excision alone and no RT
For gross hematuria from a primary bladder tumor, what palliative radiation regimen would you recommend?
I found that 36 Gy/6 Fx delivered weekly is a great option for palliation.This has been used in curative system, as well, but I find it to be particularly helpful in elderly patients or those with travel issues. There is a phase 2 study in patients who are medically inoperable and the local control ...
How do you manage a FIGO stage IB dedifferentiated endometrial carcinoma that is MMR deficient and p53 wt?
Aggressive disease. Favor chemo plus IO (MMR-d) (Van Gorp et al., PMID 39284383) followed by EBRT.
What is your approach for treating oligometastatic head and neck cancer in patients with a good performance status?
In patients with limited metastases and locally advanced head and neck cancer, we routinely offer definitive radiation therapy to the local disease, consider treatment of the metastatic site, and discuss addition of concurrent chemotherapy. The majority of these patients will benefit from locally d...