Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you ever dose escalate radiotherapy to the primary in low volume metastatic prostate cancer?
Background: STAMPEDE Arm H (SOC ± RT to prostate) allowed for two fractionation schedules, 55 Gy in 20 daily fractions (67 Gy EQD2[α/β = 1.5]) and 36 Gy in 6 weekly fractions (77 Gy EQD2[α/β = 1.5]), without correction for treatment duration), and approximately half of participants received each sch...
How do you talk with your patients regarding radiographic expectations on surveillance CT after lung SBRT?
In general, especially when I have a discussion about the 3-month follow-up scan and tell patients that the lesion may likely be stable in size, which is often normal, and not to panic. There may also be post-radiation changes that make it more difficult to initially interpret. I think this highligh...
Do you prescribe prophylactic steroids to patients receiving radiosurgery for AVMs?
I do not use prophylactic steroids when treating AVMs with stereotactic radiosurgery. In fact, usually SRS of AVMs is rarely associated with edema and these patients rarely require steroids in the observation period after SRS.
In patients with low grade gliomas that are older than 40 y/o or have subtotal resections, do you ever withhold upfront RT off protocol?
Yes. We should be humble about the data supporting RT in this scenario (that is, for IDH-mutant tumors). I would suggest that for IDH wild-type tumors (i.e., molecular GBMs) RCTs in the '70s established an OS benefit for RT and that withholding of RT is not supported.For IDH-mutant tumors, data from...
Do you constrain heterogeneity or hotspots when delivering spine SBRT for bone metastases?
We treat bone and spine mets "SRS" style which means accepting high hot spots (130%) within the GTV to allow for steeper dose fall offs just outside the target and hence lower normal tissue doses...
How do you approach a patient with stage IIA non-small cell lung cancer who received SBRT?
Well, this is a very challenging question that certainly has come up in discussions at times over the years and I could conclude with a very simple answer: No or could offer a more twisted answer arriving at the same response- just for the fun of it, let’s do the latter.So how would we, as a multidi...
Would you offer immunotherapy after chemoradiotherapy for Stage III lung cancer given results of PACIFIC Trial?
In light of the comments by Professor Vansteenkinste comparing the ESMO 2017 plenary session incorporating the PACIFIC study results as a “tsunami” in the footsteps of last year’s ESMO lung cancer “earthquake” presentations, an appropriate title to this question might be- should we let the” floodgat...
How do you compensate for treatment breaks >1 week in patients with NSCLC on concurrent chemoradiation?
Classical radiobiology dictates that some sort of treatment intensification could be indicated for a locally advanced NSCLC patient whose chemoradiotherapy course is interrupted. Though many of my patients have treatment interruptions for a variety of reasons, I almost never increase the total presc...
How would you manage treatment of keloid that is so large it requests a graft?
16 Gy/4 fractions
Is there a role for bevacizimab (IV or IA) for steroid refractory radionecrosis for AVM?
Radiation necrosis (RN) following SRS can occur at variable intervals of time following treatment, usually occurring 9-18 months later. The preferred first line of approach is usually steroids, as done in this case. I usually look at the MRI-Flair images and determine the dose of dexamethasone depen...