Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel a young man receiving EBRT as part of TNT for rectal cancer about risk of infertility?
I counsel male patients that, although the testes are outside the target dose volume, they will receive enough radiation that it could, at least temporarily, impair their ability to conceive. I offer to refer them for sperm banking prior to starting treatment.
For large AVMs that cannot meet the V12 dose constraint, how low are you willing to go in terms of single fraction dosing?
We usually use a “volume staging” approach by treating part of the AVM to 18-20 Gy in one fraction (meeting the V12 dose constraint), and return to treat the remaining nidus about 2 years later. Generally, most or all of the treated nidus has occluded by then. There will, of course, be some dose ove...
When would you offer single fraction adjuvant partial breast irradiation instead of a 5-10 fraction course for early stage breast cancer?
We have not offered a single fraction, and our standard is 26 to 30 in 5 fractions. Data on a single fraction is not enough to support this recommendation for now.
Given the final publication of NSABP B-51, for which patients meeting trial eligibility would you still recommend regional nodal irradiation?
The very first thing that should occur before one makes a decision about what they are going to do is to understand how the trial was designed and who was actually accrued to it. The first point is that B51 was a superiority and not a non-inferiority trial. A very related point to that is that they ...
When treating with electrons, what is your approach to skin collimation to reduce penumbra next to structures such as the eye?
Skin surface shielding/collimation can be accomplished by a few methods. One is to create an impression of the patient and then conform thin sheets of lead/high density shielding material to this shape with an appropriate aperture for the target. This is time-consuming but preferable for small targe...
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.
Would you use CT planning to treat a large keloid of the scalp post operatively?
We use a CT sim for almost all keloids, especially those where complex planning may be needed.Depending on the size and shape, you can even consider more complex treatment approaches, as noted in this case report: Ilori et al., PMID 35755175.
When do you start ADT for a patient with a new diagnosis of node positive prostate cancer receiving radiation?
I would reverse the question order. For node-positive disease, I start ADT once staging imaging is complete. If logistically practical (as with high-risk localized), I often perform the simulation and start ADT at the same time, then start RT without a neoadjuvant period. Evidence for neoadjuvant AD...
How are the long term results of RTOG 9802 being incorporated into practice in the treatment of "high risk" low grade gliomas?
Answer was written along with Cleveland Clinic resident, Ehsan Balagamwala, MDThe decision to treat low grade gliomas (LGG) can be very challenging. At our institution, we typically utilize the EORTC risk factors to stratify our patients. EORTC high risk is defined as having 3 or more of the followi...
How do you decide between systemic vs. arterially directed therapies in the first line setting for unresectable HCC?
In IMbrave150, 63% of patients treated with atezolizumab/bevacizumab had extrahepatic spread of disease, and my recommendation for patients with extrahepatic involvement is for first line systemic therapy. For patients with unresectable disease without extrahepatic spread, we take a multi-disciplina...