Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are any centers routinely using 55 Gy in 20 fractions with chemotherapy for definitive treatment of head and neck cancer following presentation of the HYPNO study?
I would not consider 55 Gy in 20 fractions a standard approach. The comparator arm was not standard practice in the US (66 Gy in 33 fractions with 5 weekly cycles of cisplatin at 35 mg/m2). Both the total RT dose (66 Gy < 70 Gy) and the total cisplatin dose (cumulative dose 175 mg/m2, less than the ...
Should we be stopping new starts of patients who can be triaged for 2-3 months like prostate cancers on ADT when significant community spread of COVID-19 is detectable in our area?
I would for those patients requiring ADT, which is the way I interpreted the question. I want to elaborate more because @Dr. First Last brought up other scenarios we should consider and he brings some more good points: Many patients could get active surveillance for a period of time before ADT is co...
Do you constrain the dose to the oropharynx, parotids, or oral cavity when planning HA-WBRT?
On NRG CC001, there was no inter-arm difference in reported adverse events of oral mucositis (N=6 on conventional WBRT arm vs. N=4 on HA-WBRT arm), oral pain (N=3 on conventional WBRT arm vs. N=1 on HA-WBRT arm ), or dry mouth (N=19 on conventional WBRT arm vs. N=18 on HA-WBRT arm) (Brown et al., PM...
What GTV to CTV expansion do you utilize for NPC?
Many have moved in that direction. I believe MSKCC has been doing this for years for HNC. I believe with good imaging/fusion (including MRI), doing direct GTV to PTV (3-5 mm expansion, dependent on imaging protocol) is reasonable and likely less toxic. I do this for most head and neck patients if th...
What is the role for chemoimmunotherapy in the up front setting in non-metastatic head & neck cancer outside of clinical trials?
Phase III studies of immunotherapy concurrent with chemo-RT vs chemo-RT alone, JAVELIN Head and Neck 100 and KEYNOTE-412, didn’t demonstrate a survival benefit of the immuno-containing regimens (while post hoc analyses suggested that PD-L1 positive patients may have benefited). These studies did not...
How are you using predictive tests such as DCISionRT (PreludeDx) or OncotypeDX DCIS in the management of DCIS?
Advantages: It's a relatively cheap, simple assay to better individualize risk of DCIS. Not only prognostic like Oncotype DCIS but also predictive of the absolute benefit of radiation. Supposed to be a better risk assessment tool than traditional clinical pathologic factors. Can identify those who ...
How would you treat an elderly patient with metastatic breast cancer with two new progressive right breast/chest wall lesions?
I addressed the question of how to manage patients with symptomatic breast masses in a posting on December 19, 2025. The first question for this patient with progressive lesions is whether they are symptomatic now or not. If not currently symptomatic, then I would likely defer RT until such time as ...
What are best practices for radiation oncology patient and staff precautions with the COVID-19 pandemic?
COVID Update 1/30/21 Wow, it's been almost a year. Here are some updates from our practices at University of Maryland. We have successfully treated both PUIs and COVID+ patients at all of our practices. We have yet to have a patient to staff (or staff to patient) transmission. We do not break patien...
Do you use either memantine or hippocampal sparing technique to preserve cognitive function when giving whole brain radiotherapy?
Dr. @Dr. First Last and I put together the response below:We use memantine and hippocampal sparing technique for all brain metastasis patients who are planning to receive WBRT. This is based off the recently published phase III trial NRG CC001 that found hippocampal avoidance WBRT plus memantine res...
Would you offer hippocampal sparing whole brain radiation for patients with brain metastases due to ES-SCLC?
Until we have built-in auto-segmentation, I find the RTOG contouring atlas very helpful for manual contouring of the hippocampus. I tend to use the lateral ventricle as my main landmark, and look for the circle of gray matter located medial to it. Once I've drawn a hippocampus, I'll look at it in th...