Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose of radiotherapy do you use for low volume Castleman's disease?
Reports in the literature are varied in terms of radiation dose. For scenarios such as this with low volume disease, it is probably reasonable to consider the lower end of ranges reported by others to be successful, such as 30 Gy. Careful pathology review is important for these cases as well. One mu...
How would you approach a triple negative carcinoma of the axilla with unknown primary and a CR after neoadj chemo followed by ALND?
Breast plus RNI excluding dissected axilla.
What dose constraint do you use for the spinal cord in the setting of re-irradiation?
Dr. Arjun Sahgal published the dose constraints in Red J.Reirradiation human spinal cord tolerance for stereotactic body radiotherapy.Sahgal A, Ma L, Weinberg V, Gibbs IC, Chao S, Chang UK, Werner-Wasik M, Angelov L, Chang EL, Sohn MJ, Soltys SG, Létourneau D, Ryu S, Gerszten PC, Fowler J, Wong CS,...
In light of the pending overall survival data and reported declines in quality of life associated with the PSMAddition trial, how do you envision incorporating Pluvicto into the management of mHSPC?
The PSMAddition trial was a phase III trial of [177Lu]Lu-PSMA-617 (i.e., Pluvicto) combined with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI) in patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). This trial randomized men with u...
What is the best treatment for radiation recall skin reaction of the breast?
History and distribution suggest radiation recall effect. If no agent which precipitated recall, can be ascertained then have done symptomatic management with a topical agent and follow up to see course (it subsides or gets better with time).
When treating an intact whole breast with hypofractionated radiation, how do you approach boost dosing in the case of a close margin?
In the Plenary session of the 2012 San Antonio Breast Cancer Symposium, Dr. John Yarnold reviewed all of the updates of the UK START and Royal Marsden HFRT trials and discussed the fact that 40 Gy in 15 fractions had become the standard for the UK's National Institute for Health Care and Excellence ...
When is it necessary to boost the chest wall scar post-mastectomy?
Theres is no easy answer to this question, and utilization of scar boost varies across institutions based on preferences and interpretation of scant data. Notably, the original ASCO guideline on PMRT explicitly stated that there was insufficient data to say anything about using a scar boost (Recht, ...
In patients with breast cancer, do you use bolus when boosting a chest wall scar or flap with electrons?
In terms of evidence basis for use/non-use of bolus generally in the setting of post-mastectomy chestwall radiotherapy (not limited to electron boost, noting that the use of post-mastectomy boost at all is a topic worthy of debate), here's what I found when I explored the same question a few years a...
In patients receiving PMRT do you perform a boost if they have had reconstruction (tissue expanders,…)?
Ideally I think we should make treatment recommendations prioritizing the clinical features over the reconstructive approach. The benefit of the scar boost after mastectomy is unclear, and the target for the boost is also unclear, so I tend to reserve the boost for patients with multiple high risk f...
Would you radiate the thoracic duct for bilateral chylothorax in a hematologic malignancy with no discrete adenopathy?
We have done for adenopathy, which relieves obstruction and thus helps with drainage, but we don’t know how it would help in this situation.