Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with metastatic pancreatic cancer with diffuse liver metastases, would you consider whole-liver radiation to lower bilirubin so that they are daraxonrasib eligible?
I think it is an interesting idea. However, I would not expect the TB to decline after RT. Stable, maybe, but not a decline. If TB is rising, that is from parenchymal destruction, and radiation will not reverse it. If obstructive, only stenting would make sense.
When do you consider neoadjuvant radiation for inflammatory breast cancer?
I utilize neoadjuvant radiation only in the setting of a patient inoperable following neoadjuvant chemotherapy. I have used xeloda + radiation in such situations as well.
What is the role of neoadjuvant breast radiation in patients with triple negative breast cancer progressing on AC-T?
There is no standard treatment in this setting. If a patient is not a candidate for clinical trial, we have been doing RT with concurrent carboplatinum or xeloda with the hope of making the disease operable. In our experience, response is mixed with a set of patient making it to operable stage.
Is there a rationale for treating medically inoperable stage I-III breast cancer patients with RT alone?
We treated stage III patients with "radical radiotherapy" with or without chemotherapy when I was a resident in the early 1980s, since they were considered SURGICALLY inoperable then. However, very high doses were needed (75-80 Gy to the primary using external beam followed by interstitial implants)...
When treating locally advanced breast cancer preoperatively that is progressing on neoadjuvant chemotherapy, to what doses do you treat the gross disease, breast, and regional nodes?
I typically treat 50 Gy to large fields including the entire breast and regional nodes and take any gross disease to 60-66 Gy. I also discuss with my medical oncologist the possibility of concurrent xeloda as well.
What RT dose/fractionation would you use to treat an unresectable grade 3 solitary fibrous tumor abutting the optic nerve and chiasm?
Generally, I would consider treating an unresectable grade 3 solitary fibrous tumor to up to 59.4/60 Gy, or possibly higher. The location of this tumor makes it difficult to treat entirely using this dose while respecting the optic nerve/chiasm constraints. How is the patient's vision? If intact, op...
In a patient with isolated inguinal nodal recurrence one year after a margin negative anal excision for Grade 1, T1 SCCA of the anus, would you include the anal canal/rectum as part of salvage chemoradiation therapy?
Absolutely yes- the risk is lower for T1 8-10 percent but it is possible. Given the failure should include the entire anal canal and RNI to at least 45 /25 and can SIB gross node to 50 plus depending on size. Anecdotally I had one case like this , resected small T1, node failure where only the ingui...
How do you advise a patient with a history of HR+ breast cancer who would like to go on HRT for postmenopausal symptoms?
I would say systemic hormone replacement therapy is generally not recommended because of concerns about recurrence. I would assess the severity of symptoms and explore non-hormonal options. If her main concern is vaginal symptoms, low-dose vaginal estrogen may be an option depending on the severity ...
Is salvage SBRT an option for focal recurrence of PCa after prior proton therapy for intermediate-risk disease?
Yes, it is an option. There is a great need for randomized trials in the setting of local-only recurrence after definitive RT, and we do not know the optimal approach. The MASTER systematic review and meta-analysis is a good summary (Valle et al., PMID 33309278). I do not think that protons vs. phot...
Would you offer ultra-hypofractionated breast radiation for a patient with a 4.5 cm IDC but otherwise favorable characteristics?
Tumor size is not a limiting factor for selecting the 5-fraction regimen (FAST-Forward). Dose distribution is more important. A boost would be added, especially for patients younger than 50.