Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a patient who has a large DCIS status post mastectomy and implant with extensive positive margins?
I would treat with PMRT to 50 Gy in 25 fractions followed by boost as it looks like the patient has a significant margin positive.Based on the location of implant (pre pectoral or retro pectoral) contouring and at risk volume is different. The consensus guidelines addresses this: https://www.ncbi.nl...
Would you dose escalate neoadjuvant radiotherapy for T3 and/or N+ rectal cancer in patients who are unwilling or unable to get chemotherapy?
If a patient with rectal cancer is not able and/or unwilling to receive concurrent radio-sensitizing chemotherapy with pre-operative intent radiotherapy, I would recommend the use of short-course radiotherapy with 25 Gy in 5 fractions.Multiple trials, including TTROG 01.04 and Polish 1 Bujko et al.,...
How are you clinically incorporating the data presented from RT Charm at ASTRO 2024?
This is an appropriate question with the presentation of RT CHARM at ASTRO a few weeks ago. We have been utilizing hypofractionated NON-reconstruction PMRT and regional nodal breast RT for years in my practice given our large geographic catchment area. As a general rule, I feel it's always best prac...
Would you recommend MRI post surgery and pre-irradiation for patients with extensive DCIS and close margins and how would it impact your management?
MRI post-op may be hard to interpret. Favor mammogram especially if had microcalcifications pre-surgery, it makes sure they are all removed.
Does location of an non-spinal osseous metastasis affect your SBRT dosing?
Just a few thoughts: Location is an important consideration for SBRT dosing because normal tissue tolerances vary by organ/location. Three complications that I worry about are the risk of bone fracture, neuropathy and myositis when treating non spinal osseous mets with SBRT, especially in the settin...
For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?
It depends - favorable/unfavorable, distribution of disease, co-morbidities, gender, family history, etc. I don't treat pediatric patients, so the comment below applies strictly to young adults.If a patient has early-stage, favorable HL per GHSG criteria (no risk factors), then 2 cycles of ABVD + 20...
For patients receiving TNT for locally advanced rectal cancer who have received chemotherapy prior to chemoradiotherapy, do you treat the pre or post-chemotherapy volume for the boost, especially in patients who have had a near complete response?
I base my boost volume upon the pre-chemotherapy extent of gross disease. Times I have selectively deviated from this are almost exclusively related to unfavorable normal tissue anatomy (i.e., significant volume small bowel deep in the pelvis) such that covering the initial extent in the boost volum...
How do you counsel patients receiving head and neck radiation regarding its impact on both existing and future dental work?
We send any patient who is having any portion of the maxilla or mandible to their primary dentist for an evaluation. If there is anything other than a simple restoration, we refer patient to a set of oral surgeons we work with for evaluation. They ensure any pre XRT dental root work is completed and...
Do you recommend prophylactic hyperbaric oxygen for patients who require tooth extraction after head and neck radiation?
The benefit of prophylactic HBO before extraction in HNC was determined in a single randomized study from 1985 (Marx RE et al), where pts received 2D RT, likely delivering the full tumor dose to the posterior mandible. However, using IMRT sparing the non-involved mandible (and producing a dose gradi...
Is there a threshold dose to the mandible above which you consider prophylactic HBO prior to dental extractions that are required after RT?
We do not consider HBO before extraction from parts of the mandible that had received high doses. If ORN happens, we would refer the patients to surgical debridement of the affected area if it does not heal spontaneously. Our experience is that strict prophylactic dental care, as well as IMRT aiming...