Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel eligible patients on lung cancer screening who are hesitant because of the cancer risk from CT scans?
This is simple. The risk of lung cancer in patients who have smoked for >20 years is orders of magnitude higher than the theoretical risk of medical X-ray-induced cancers from low-dose CT (LDCT) screening. A typical LDCT scan exposes patients to approximately 1.5 mSv of radiation, equivalent to abou...
What constraints do you use for the BID small cell lung cancer regimen?
The best validated constraints are from CONVERT (CALGB 30610/RTOG 0538). Cord D0.1cc < 41 GyEsophagus mean < 34 GyHeart V60 < 33%Heart V45 < 67%Heart V40 < 100%Lung V20 <40%Lung mean < 20 GyAlthough I tend to push for the LU005 constraints which I think are slightly more conservative.In addition to ...
Are there reasons to not use prostate SBRT when treating the prostate +\- proximal SV?
Early trials such as HYPO-RT-PC which aimed to validate a 7-fraction SBRT dose schedule by comparing it to the standard of care at the time, conventionally fractionated EBRT, utilized a treatment volume consisting of the prostate alone without the seminal vesicles (SVs). While there was some suggest...
What is the optimal duration of ADT for unfavorable intermediate risk or high risk localized prostate cancer treated with SBRT instead of conventionally fractionated or hypofractionated RT?
There is no available data from randomized trials to support any modification in the choice of ADT (GnRH agonist vs antagonist) or use of abiraterone acetate, or on the duration of ADT (4-6 mo vs 2-3 years) based on the form of radiation, and thus I follow the NCCN guidelines that provide recommenda...
What resection margins are required for DCIS with a component of invasive disease?
The SSO-ASTRO-ASCO guidelines of 2016 on margin status for patients with tumors that are pure DCIS or predominantly DCIS requiring a minimum of 2 mm for those receiving RT were based on a meta-analysis of (mostly older) published studies, not individual patient data. Three much more recent studies f...
For locally advanced breast cancer, to what dose do you treat undissected clinically positive level III axilla, SCV or IM nodes?
At MD Anderson Cancer Center, we systematically stage the regional nodes using ultrasound. We biopsy suspicious nodes with FNA at the time of ultrasound. Given this systematic approach to staging, we have a large experience treating patients with biopsy-confirmed infraclavicular, supraclavicular, an...
How does the potential for a patient to accept or forego adjuvant tamoxifen factor into your recommendations on adjuvant RT for DCIS?
In the RTOG 9804 trial, the only factors predicting for local control in the breast were the use of radiation and of tamoxifen. So for women who have hormone positive tumors, I strongly advocate for some treatment in addition to the lumpectomy.I find the results of the UK, Australia, and New Zealand...
For a cutaneous malignancy near the eyelid, how do you decide whether to use an internal eye shield or an external eye shield during treatment?
If the target is the eyelid, then use an internal eye shield.
How have you incorporated ctDNA into the clinical management of patients with gynecologic cancers?
ctDNA certainly is increasing rapidly in oncology and has been led by several other disease sites. I think right now, GYN oncology is figuring out how to incorporate this in our care to meaningfully impact our patients. I have not incorporated ctDNA in my practice routinely, but do see the role of i...
Is 60 Gy in 40 fractions BID an appropriate regimen to use for LS-SCLC now?
The reported results are very interesting and potentially practice changing. The 45 Gy BID was developed in 1983, doubted since then but undefeated in large prospective trials including the RTOG/CALGB trial presented at ASCO. Its 5 week arm with partial 1.8 BID for part was dropped. Four weeks BID w...