Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there any volumetric constraints associated with toxicity in the dose range that is moderately above prescription (i.e. 30-35 Gy range), when planning hippocampal-sparing whole brain radiation?
This is an important question worth some discussion. As the question mentions, clinical trials of HA-WBRT have permitted a hot spot of 133% of the prescription dose of 30 Gy (or 40 Gy) to D2% of the whole-brain parenchyma as an acceptable protocol variation. Importantly, none of these trials have de...
How would you manage an elderly female patient with a remote history of synchronous bilateral invasive ductal carcinoma with a new triple-negative recurrence in the left breast and axilla with extension to the contralateral breast?
Unfortunately, if no good systemic options are left including pembro/parp inhibitor then the outcome is most likely palliative. Will try a hypofractionation schedule for palliative/preoperative dose of RT.
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...
How do you talk to patients with intermediate-risk prostate cancer deciding between LDR brachytherapy (monotherapy) vs HDR mono vs SBRT vs EBRT, in terms of the comparative side effect profile of each approach?
It’s hard to add much to Dr. @Dr. First Last's excellent evidence-based answer, but I’ll elaborate on the counseling aspect from my perspective. Introduction: I start by acknowledging how difficult it is to weigh several totally foreign options and acknowledge the gravity of the decision. My patient...
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...
Can we use a linear accelerator to sterilize PPE?
Per FAQ's posted by ASTRO: "At this time, ASTRO does not recommend the use of clinical linear accelerators to sterilize PPE. While ionizing radiation is used for sterilization of blood and food products, this is achieved using industrial irradiators that use gamma irradiation at doses rates far grea...
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 weigh the disease control advantage of SBRT for bone metastases in Ewing sarcoma against potential late skeletal effects of high-dose-per-fraction radiation in a growing child, given limited long-term data in this population?
SBRT with a higher dose per fraction is likely to be similarly stunting in growth potential as conventionally fractionated high-dose radiation to 50-55.8 Gy. There is likely to be essentially no difference in growth stunting potential, and SBRT has the advantage of smaller margins added (less normal...
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...
How do you follow patients after SBRT for NSCLC?
When we started our lung SBRT practice almost 13 years ago, the follow up schedule was based on trying to measure the benefits and impact of the therapy in a fairly structured fashion so that we could develop expertise in understanding outcomes, radiographic changes, patient experience, and treatmen...