Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Do you ever start patients on a Friday if non-emergent and you're not treating over the weekend?
The data for reducing radiation treatment time/elapsed days are most obvious in the setting of squamous cell carcinomas (SCC), where data have shown in H&N cancers, cervical cancers, and anal cancers that shorter treatment times are important for optimal local control. One study that I find intrigui...
Would you recommend prostate re-irradiation using SBRT?
Yes, we offer it for patients who had prostate cancer, underwent definitive radiation, have failed by Phoenix criteria, and have a PSMA PET confirming no metastatic disease.We obtain an MRI of the prostate and our Urologists perform a full TP biopsy + biopsy of ROI to identify areas of active diseas...
How do you reconcile discordant PSMA and MRI findings in patients undergoing definitive radiotherapy for prostate cancer?
In the situation wherein you found something on PSMA PET that wasn’t seen on MRI, I would obtain a biopsy for 2 reasons: 1. In order to confirm the presence of distant metastasis or 2. If tissue is needed for genomic testing. Otherwise, I would not biopsy in the case of discordant imaging, since I w...
Would you consider long course pelvic CRT after neoadjuvant chemotherapy in a patient with low lying, locally advanced rectal adenocarcinoma when you're unable to meet small bowel constraints?
I would definitely offer long course chemoradiation in this setting. The V15 small bowel is not a constraint that should be used to determine treatment. The only absolute constraint I use for pelvic chemoradiation for rectal cancer is a small bowel maximum dose of 55 Gy. The 55 Gy maximum dose const...