Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How long can you delay the start of radiation in a patient who has received adjuvant chemotherapy after lumpectomy/mastectomy?
I generally start radiation between 3 and 8 weeks following the last dose of chemotherapy. Since most protocol guidelines specify radiation should start within 12 weeks of the last day of chemo is within the last surgical procedure, I use that as an outside window I am comfortable with for the most ...
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...
Does pleural tenting adjacent to tumor impact your target volume for early stage NSCLC planned for SBRT?
Having reviewed the images in the cited paper, the question of how to define the target for tumors with proximity to the chest wall and that also show pleural tenting is one that my thoracic radiation oncology colleague will often discuss. The brief answer is that although tenting likely represents ...
What resection margins are required for DCIS with a component of invasive disease?
The SSO-ASTRO-ASCO guidelines of 2016 on margin status for patients with tumors that are pure DCIS or predominantly DCIS requiring a minimum of 2 mm for those receiving RT were based on a meta-analysis of (mostly older) published studies, not individual patient data. Three much more recent studies f...
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...
For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?
This is an important question; however, the answer is unknown. The key outcome that should be the focal point for the best treatment option, is which treatment strategy results in the most optimal patient reported quality of life and bowel function. Currently, this remains void of prospective, rando...
What factors do you consider when selecting dose/fractionation for whole brain radiotherapy?
I assume this question is for brain metastases patients who are not eligible for hippocampal avoidance WBRT (ineligible criteria including but not limited to - mets 5 mm within either hippocampus, germ cell/small cell/lymphoma, leptomeningeal disease, etc.) - my default WBRT dose fractionation is 30...
Would you recommend adjuvant radiation therapy to the locoregional lymph node basins for Merkel cell carcinoma (MCC) s/p WLE with negative margins and isolated tumor cells in 1 of 3 right inguinal sentinel lymph nodes?
Yes, this is not an easy disease to cure in the node-positive setting. So, the question can be framed: do isolated tumor cells constitute a benign finding, frank malignancy, or a space in between? I don't have an answer to that, and perhaps given the rarity of the entity, that answer will remain rec...
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...
For a patient with metastatic melanoma with small, asymptomatic brain mets what is your preferred systemic therapy?
I lean towards ipi 3 mg/kg and nivo 1 mg/kg per the clinical trials, with very close interval follow-up with brain MRI at around 6 weeks to assess for response. Certainly not unreasonable to radiate then do Nivo/Rela as well. I tend to radiate before Nivo/Rela since the brain met data is less robust...