Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage the thickened secretions secondary to xerostomia during head and neck radiation?
I find that the management of acute effects of RT for H&N treatment is somewhat of a dark art. What works for one patient may not work for another. The thickened secretions are from acute irritation of the salivary glands and not so much from "xerostomia" during the acute phase of RT. For thickened ...
How do you manage a symptomatic primary breast tumor in a patient with metastatic disease?
It’s much harder to treat patients palliatively than to cure. The art of palliation generally requires weighing the acute and subacute toxicities of alternative treatments much more heavily and chronic toxicities less than we do for potentially curative care. It also requires assessing whether patie...
Are there any scenarios in which you would offer SBRT as your preferred treatment approach for appropriate candidates with intermediate risk prostate cancer?
Based upon the PACE-B trial, 40 Gray to the prostate, 36.25 to the PTV, which was compared to standard or moderately hypofractionated radiation, and documented non-inferiority. It is reasonable to consider stereotactic radiation therapy as a standard of care for intermediate-risk prostate cancer. If...
Do you use an LAD constraint in the setting of BID thoracic radiation for SCLC?
The literature is convincing that an increasing dose to the heart (using whole-heart dosimetric parameters) is associated with an increased risk of adverse cardiac events and decreased survival. Recent and current investigations have attempted to correlate dose to specific cardiac substructures with...
In a patient with metastatic breast cancer who has progressed on multiple medications and has now developed multiple brain metastases, what is your radiotherapy plan if the patient is taking sacituzumab govitecan?
The limited published data have not shown increased complications with SRS along with sacituzumab, unlike increased necrosis seen with HER2/neu antibody conjugate. Khatri et al., PMID 41026418
How would you alter your treatment volumes in a patient with distal esophageal cancer who has had prior gastric bypass surgery?
Some additional context would help in answering this question. For example, is this patient a surgical candidate and is the intent of radiation as part of preoperative treatment, or is this definitive therapy in an unresectable patient? Also, what is the concern that is leading to the question? Is i...
In a patient treated with peri-operative chemotherapy via the MAGIC regimen for gastric cancer who has a locoregional relapse in unresectable celiac node, how would you approach radiation treatment?
I would give an ablative dose to the node. These nodes are usually not near GI structures. I would electively treat the PA, portal, and splenic artery nodes with a microscopic dose at least down to the level of the IMA. I would not electively treat the remnant in the salvage setting. Dose options d...
How would you treat a stage I peripheral <3cm extranodal marginal zone lymphoma of the lung? Is SBRT appropriate? If so, what dose would you use?
Marginal zone lymphoma of the lung is a very uncommon variant of MZL but appears to have the same favorable outlook as MZL in other locations. Standard dose for localized MZL is 24-30 gy (2gy per fraction) with lower doses generally used in the eye with local control exceeding 90%. Investigations ar...
Do you use an SIB schema for salvage post-prostatectomy RT when treating the fossa in ~33-39 fractions and including the pelvic lymph nodes?
Some have adopted 25 fraction regimens with the simultaneous delivery of 62.5 Gy to the operative bed and 45-50 Gy to the regional pelvic lymphatics, in part based on the randomized NRG-GU003 (Buyyounouski et al., PMID 38483412), which should be reporting updated results on efficacy and toxicity lat...
Would you consider offering salvage radiation to a patient with castrate resistant prostate cancer who has never had local therapy and has no evidence of lymph node or distant metastasis?
It's hard to give a great answer without knowing more information, such as the PSA, Gleason score, and T-stage at presentation, why he was treated with androgen deprivation alone up front, what AD he was treated with, how long he was under treatment before he became castrate resistant, and what is t...