Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it safe to deliver palliative spine radiation concurrently with sacituzumab govitecan?
There are simply not enough data to confirm the safety of concurrent sacituzumab govitecan and RT. As palliative spine RT typically entails a short course (cEBRT using 8 Gy in 1 fx or 20 Gy in 5 fxs or SBRT using 2-3 fractions) of treatment, holding the medication for a week during RT should not imp...
When do you use a vaginal cuff boost with pelvic RT for stage II endometrial cancer?
Most prospective studies studying the role of external beam in endometrial cancer have treated patients with pelvic radiation (46/2 Gy or 50.4/1.8 Gy) without any brachytherapy. These studies have reported very low rates (2-3%) of in field failure in the radiation arms, so recommending external beam...
For vaginal cylinder HDR in the setting of adjuvant endometrial cancer radiation, do you routinely alter the prescription dose based on the diameter of the cylinder?
The prescription dose will remain the same regardless of the size of the cylinder that is used and should be specified to the vaginal surface (often 6 Gy x 5) or to 5 mm depth (often 7 Gy x 3). Because of the inverse square law, the dose to the non-prescription point will vary as a function of cylin...
Do you have any normal tissue constraints for endometrial cancer patients receiving EBRT and vaginal cuff brachytherapy?
We use following constraints for EBRT35 Gy to less than 35% of bowel bagRectum 40 Gy less tha 40-60% Bladder 40 Gy less than 40-60%Bone marrow ( pelvic bone) V20 less than 75% Femoral heads V35 less than 5%for brachy as adjuvant we give 5 Gy x2 to thickness of vaginaSince total dose loss limit and p...
Is it appropriate to consider ultra-hypofractionation for phyllodes tumors of the breast when adjuvant radiotherapy is indicated?
I have used moderate hypofractionation for patients with phyllodes tumors for whom the logistics of coming for conventional fractionation were too great. However, I agree with Dr. @Dr. First Last that there are no data yet supporting this for phyllodes tumors specifically. Further, the issue of whet...
Is there any role for adjuvant radiotherapy for resected multistation N2 atypical carcinoid tumor of the lung?
Carcinoid tumors, whether typical or atypical, are not very responsive to radiotherapy. Adding the feature of “multi-level N2 nodes”, the prospect of local and systemic recurrence increases. So, to many, this bolsters the logic to offer thoracic radiotherapy. These tumors are also not very responsiv...
Should ultra-short course RT be standard for elderly or poor performance status patients with glioblastoma?
The recent phase III randomized trial published by Roa et al. examining the efficacy of short course radiotherapy in elderly and/or frail patients with newly diagnosed GBM builds upon his previous work finding equivalent outcomes in elderly patients (age > 60 years) receiving 60 Gy in 30 fractions ...
Is there anything you use for patients with anticipatory nausea who has failed Ativan and Zyprexa?
I know of no data, but I would consider hypnosis, mediation and mindfulness, cognitive behavioral therapy, acupuncture, and medical marijuana as possible options for anticipatory nausea refractory to lorezapam and Zyprexa. Hypnosis, mindfulness, and cognitive behavioral therapy are in a sense are re...
For adult intracranial (posterior fossa) ependymoma, how do you approach spinal cord constraints with planning to 54-59.4 Gy?
As you have realized, there is no way to keep SC to 54 with this prescription, and the more important point is: where does the radio-sensitivity of the brainstem transition to the spinal cord? After all, the distal brainstem is really a series organ as well. So, given that the control of disease is ...
What is your experience with Pylarify vs. Posluma PSMA PET for prostate cancer and is one preferred over the other?
There is no definitive evidence at this time that one of these imaging agents is clearly superior to the other because there are no comparative data in the same patient group.For Posluma, the potential benefit over Pylarify would be lower bladder excretion allowing for better visualization of the pe...