Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Given the results of ESOPEC from ASCO 2024, for which patients with resectable esophageal adenocarcinoma would you favor neoadjuvant chemoradiation?
It is a great question and something that I think all of us are still wrestling to digest and readjust our treatment algorithm for patients with esophageal cancer. First, I think Dr. @Dr. First Last did an outstanding job putting ESOPEC in context in the esophageal cancer treatment landscape. In add...
Would you consider simulating a patient with brain metastases in the prone position if they are unable to tolerate lying supine for SRS treatment?
I have taken care of many sick and quite comorbid patients with brain metastases and have not yet run across the situation - mainly because someone with poor enough performance status that they cannot tolerate a supine positioning awake, or under anesthesia, is typically not an ideal radiosurgery ca...
Is there a risk of increased side effects with combined radiation and ibrutinib therapy?
It is increasingly common to see patients with various hematologic malignancies requiring palliative RT who are on small molecular inhibitors (such as ibrutinib) or other novel agents. There is often a dearth of information in the medical literature regarding the safety of combining RT with these dr...
How would you manage simultaneous locally advanced NSCLC and locally advanced head and neck cancer?
Agree with Dr. @Dr. First Last, however, if planning to treat these synchronously, I would favor two setups, one for lung and one for HN. I would want to keep doses in lung tight to minimize toxicity as much as possible. Having to fight with arms and butterfly arcs is going to make that much tougher...
What radiation dose is a risk for damaging function or active leads from a pacemaker?
Lots of attention has been placed on the dose to the device itself (and to a lesser extent the leads of implanted devices such as pacemakers). The type and purpose of the device are very important and plays a role in what is permissible dose to the unit. For example, the risk to a pacemaker (PPM) on...
How do you sequence thoracic consolidation RT and PCI with incorporation of immunotherapy in ES-SCLC?
In the IMpower133 study, "during the maintenance phase, prophylactic cranial irradiation was permitted as per local standard-of-care, but thoracic radiation with curative intent or the intent to eliminate residual disease was not permitted. Palliative thoracic radiation was allowed. (quoting from th...
How do you incorporate PCI into your management of patients with extensive stage SCLC?
The role of prophylactic cranial irradiation (PCI) in the modern era of brain MRI surveillance has been called into question and is the topic of the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- PCI (or hippocampal avoidance [HA]-PCI) for LS and ES-SCLC, where I serve as the prin...
Do you take the primary dissected site for postoperative oral cavity cancers with bony invasion to 66 Gy?
Dr. @Dr. First Last correctly addresses the nuanced indication for PORT due to bone involvement.60 Gy is embedded in the PORT culture. For at least 30 years, RTOG trials have recommended 60 Gy with an optional boost to 66 Gy for PORT, though the EORTC trial (Bernier et al., PMID 15128894) went to 66...
What prostate size, if any, is a relative contraindication for external beam RT?
I do not view the prostate size itself as a contraindication on its own to EBRT. I believe the largest prostate I have treated was ~350 cc. The things to keep in mind when treating any prostate patient, but especially when gland sizes are large, are: 1. How well was the gland sampled? MRI can be ver...
How does the presence of interstitial lung disease affect your decision to offer SBRT for early stage NSCLC?
As opposed to interstitial lung disease (ILD) in general, the entity most described in the literature as associated with severe pulmonary toxicity after SABR has more specifically been idiopathic pulmonary fibrosis (IPF) and additionally, in the absence of a known diagnosis of IPF, CT findings consi...