Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For a patient with glioblastoma also found to have a distant presumed meningioma with a location/size such that you would have otherwise recommended RT, would you offer concurrent treatment?
I think if the situation is non-urgent and the lesion (meningioma) can be safely monitored, one approach would be to prioritize treatment of the glioblastoma while observing the meningioma. If, however, the meningioma demonstrates interval growth and/or is located in an area at higher risk for causi...
What is the longest acceptable interval between hysterectomy and vaginal cuff brachytherapy for high/intermediate risk endometrial cancer in the age of COVID-19?
We usually start no later than 9 weeks post hysterectomy. It is based on this retrospective study.
In light of the ROADS data, how are you choosing between intraoperative tile-based radiation therapy (TBRT) and postoperative SRT for newly diagnosed resectable brain metastases?
In light of the ROADS data, I would be cautious about broadly changing practice at this point. While the local control benefit with cesium-131 GammaTile is impressive and biologically plausible, reported OS is much harder to reconcile. A 26% absolute improvement in 2-year OS from a local therapy int...
Is pre-treatment nodal ultrasound evaluation necessary if a patient undergoes upfront PET/CT for staging?
The answer to this question depends greatly on the local capabilities to conduct regional nodal ultrasound. If this can be done, then we find ultrasound to be very helpful. In today’s environment, it is difficult to obtain insurance approval for PET in the staging of node-positive breast cancer. Bey...
How do you approach the decision to boost patients diagnosed with DCIS?
Based on prospective and also retrospective data Chua, AACR Volume 81, Issue 4 Supplement, pp. GS2-04. We would recommend for high grade, < 50 years and close margin and in the era of genomic testing to patients with high genomic score.
How do you minimize skin toxicity when targeting neck nodes in a patient with HNSCC and skin folds in the neck?
A few technical things in general to avoid grade 3 dermatitis: Mask Fit and Immobilisation • Ensure optimal thermoplastic mask fitting in the lower neck and SCF region at the time of CT simulation. • Minimise air gaps between mask and skin; air gaps impair accurate surface-dose calculation and cause...
When treating inguinal lymph nodes in the setting of pelvic RT, what is your preferred setup in order to minimize dose to the penis?
I have tried a variety of different setups but have found that building a scrotal shelf works the best. The patient is set up supine in the frog leg position using your immobilization method of choice. I then use a custom moldable headrest and place it against the perineum to serve as a shelf for th...
Under what circumstances would you consider omitting radiation in patients with early stage, unfavorable (bulky) Hodgkin Lymphoma?
We should first acknowledge that combined modality therapy improves progression-free survival in early-stage HL compared with chemotherapy alone. Stated more succinctly- if you give combined modality therapy, there is a lower risk of relapse; if you give chemotherapy alone, there is a higher risk of...
How do you manage spinal cord compression in a new suspected neuroblastoma diagnosis?
While there is evidence that chemotherapy, surgery, and radiation can all be effective for some patients,1 there are no definitive studies or data that prove the best approach for all patients. A 2017 systematic review concluded that the “currently available literature remains suboptimal as a guide ...
What treatment volumes and dose do you use for postoperative soft tissue sarcoma of the scalp with negative margins?
While there is institutional variation in practice, our standard has been to extend extremity/trunk paradigms to the head and neck region, including the scalp. For negative margins for a scalp sarcoma, we typically use margins of 3-3.5 cm for CTV for the first course and then 1.5-2 cm CTV for the co...