Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there dosimetric scenarios where using a FFF beam would be beneficial in a non-modulated beam, like AP/PA or 3D conformal?
Except for less treatment time, the rest would all be less advantageous with FFF, as it takes more time to plan, and the dose is less uniform when using it for 3D conformal RT.
Is there evidence to support bladder preservation therapy in node positive bladder cancer?
Although there aren’t randomized data suggesting the superiority of trimodality therapy (TMT) over any other treatment for N+ bladder cancer, I think most feel that it is the standard of care as alluded to in the question. Broadly speaking, patients and providers have two options: radical therapy or...
When do you refer a patient with recurrent glioma for reoperation?
This question is a nuanced one that is dependent on many factors. When a patient has a recurrent glioma, the treatment options are generally re-resection, medical therapy (traditional chemotherapy or targeted agents, depending on the tumor), or radiation. Which treatment modality, or combination of ...
How would you treat a patient with UC and a J-pouch presenting with basaloid carcinoma of the prostate who is not a surgical candidate?
This is a difficult scenario. One way of approaching this is by considering SBRT to the prostate and seminal vesicles after placing a rectal spacer. The typical dose is 3,625 cGy in 5 fractions, given on alternate days. Ensuring there is no bowel (small or large) within proximity of the superior asp...
With the addition of pembrolizumab following chemoradiation per KEYNOTE-A18, would you be less likely to treat the paraaortic chain prophylactically?
I would favor the same volume of RT with or without pembro. If there is an indication to treat PA nodal chain, would treat as per plan.
How would you treat a patient with isolated CNS relapse of seminoma?
As one would expect there are really no reliable data to use to make decisions. I am assuming that there is no significant elevation of HCG or AFP? Typically, I would first recommend engagement of a high-volume center to review details of the case and get guidance. This is a highly unusual setting f...
What is your approach to women with breast cancer who opts for a staged approach with up-front lumpectomy and SLN biopsy (pN-) when there are indications for adjuvant radiation therapy but she plans for a later mastectomy (=>6 months)?
I would not offer RT if planned for mastectomy in 6 months, as based on phenotype, median time for recurrence is 2 to 5 years, and RT can also negatively impact the cosmetic outcome with reconstruction.
How do you approach adjuvant radiation recommendations for low-risk endometrial cancer in which the patient was unable to undergo pelvic sentinel node mapping?
Nodal assessment would not change much for me, as it’s a low-risk disease, and PORTEC data have shown the risk of nodal recurrence is low. For focal LVSI, one may consider brachy alone.
How does a pathological CR to neoadjuvant chemotherapy influence your practice for the use of bolus with adjuvant PMRT patients without inflammatory breast cancer, but who would meet traditional risk factors for skin involvement?
I would favor a bolus for the first half of treatment.
Do you offer hypofractionation or RNI for a pT1N0 high-grade primary neuroendocrine carcinoma of the breast?
Hypofractionation with a boost, yes. No RNI if the SNLN is negative.