Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How long would you wait before considering additional treatment to the same site if bone metastasis pain fails to improve after 8 Gy x 1 fraction?
There is unfortunately very little published evidence to help guide the answer to this very important question. It's potentially a big topic, so I am going to attempt an answer from a spine reirradiation perspective (Reirradiation of other sites such as weight-bearing long bones may have different c...
How do you approach postoperative radiation for small oral cavity cancers cases with limited risk factors?
LVI is considered a minor risk factor in HNC, similar to PNI, but data regarding its exact prognostic effect and whether it alone deserves adjuvant treatment are scant. For example, a large MSKCC of OC patients found LVI in only 11% of patients, compared with 25% of patients with PNI (Zaromi et al.,...
How do you define your treatment volumes when treating a patient with post-mastectomy radiation therapy?
There are several ways to define treatment volume with PMRT. 1) The way that I have handled these cases is to wire out the chest wall and chest wall scar at sim and use this to create my treatment volumes rather than contouring. If the drain site is in the volume I cover it but otherwise dont extend...
How would you manage a prolonged treatment break in the middle of lung SBRT for early stage NSCLC?
I’ve never had this particular scenario occur but I likely wouldn’t change total dose or fractions unless we are talking about an essentially new course type of delay. Not lung but there is data from the University of Michigan in 2019 looking at an intentional 4-week break after fraction 3 of SBRT f...
How do you approach Lu-177 use in taxane-naive patients with metastatic prostate cancer?
At this time in October 2024, Lu177-PSMA-617 is not yet approved in taxane-naive mCRPC, and decisions on its use and availability hinge both on USFDA approval in the coming months as well as NCCN guidance, which has not been updated at this time. Until then, decisions to pursue this radioligand ther...
For a patient who has vaginal cuff recurrence <6 months after adjuvant pelvic radiotherapy to a dose of 45 Gy, how would you approach management?
If amenable to a potentially curative brachytherapy approach, I would generally want to do this first and then give systemic treatment. The risk of local progression during systemic treatment is significant, and if this occurs, the patient has often lost the chance to be cured. However, if the decis...
How do you sequence ADT relative to the start of RT?
Happy New Year to the MedNet! This is a great question that should remind us to question everything. This is an important question that the prostate community I have felt since I was in training has over simplified for decades. First: Our current nomenclature has problems. Most residents and facult...
Do radiation oncology missions to developing countries actually provide a means for sustainable cancer care?
The cancer burden is large and growing in developing countries. In many parts of the world, cancer awareness is low and currently available infrastructure is insufficient to support the growing burden of cancer. For many years, cancer was thought to be a disease of affluent countries. With the impro...
Do you treat adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) of the lung with SBRT in medically inoperable patients?
The literature on this for SBRT is quite thin. We looked at our institutional experience a few years ago using SBRT for MIA/AIS. You'll have to excuse the onerous title. It was published right around when we started switching away from the term BAC, and we wanted to make sure folks could find it!We...
Is there still a role of brachytherapy in uterine cancer if intensity-modulated radiation therapy is available?
Yes. Brachytherapy is still more conformal than optimally planned IMRT.