Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer SBRT/hypofractionation for stage I NSCLC with positive margins after resection?
I agree that it feels a bit disingenuous, in an era where we can provide precision delivery to areas of the lung with high control rates and low toxicitity, to offer standard PORT over 5-6 weeks.However, I think the first question is not how to delivery RT, but whether to deliver it?The most relevan...
Do you treat bulky pelvic/retroperitoneal lymph nodes for prostate cancer to palliate lower extremity lymphedema?
Yes usually would use 35-40 Gy at 2.5 Gy per fraction
What factors do you take into account when deciding to offer SpaceOAR to patients with prostate cancer planning to undergo radiation therapy?
A shared decision-making opportunity. It has been interesting to see the pendulum of physician opinion swing back and forth a bit on this issue. [For those unfamiliar with the topic, in addition to reading the initial RCT results, it is worthwhile to read the later Lancet commentary: Hall et al., P...
Based on the results of CALGB 80803, would you consider induction and/or concurrent FOLFOX in neoadjuvant treatment of esophageal adenocarcinoma?
Great question. The CROSS regimen has been our standard for resectable GE junction and esophagus adenocarcinomas, but the data from the CALGB 80803 study are compelling.For some patients with questionable disease resectability, usually due to extensive nodal involvement, we have been giving “inducti...
How do you manage residual hyperpigmentation after breast irradiation?
There are definitely options, including modified Kligman formula cream (4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetonide) for 8 weeks as initial treatment; this - or some iteration of it - is what is typically used for cases of post-inflammatory hyperpigmentation (PIH) or melasma. ...
What treatment fields and dose do you use in the treatment of postoperative angiosarcoma of the scalp?
This is hard disease to treat with high propensity of local and distant relapse . The volume of treatment varies based on extent of involvement as most of the time it presents as diffuse disease and you end up treating almost entire scalp. But if lesion is small one can treat with limited field with...
What dose/fractionation would you recommend for a prostate patient who previously received 1 of 5 planned fractions SBRT in 2020?
Tough case and a reminder of all the continuing fallout from the pandemic. My TL;DR is it's fine to deliver full dose and basically ignore the prior RT delivering as conformal and safe a plan as you can this time around. A couple more wordy thoughts:1. What's the benefit?For a man with very high-ris...
How do you approach the discussion and decision-making regarding surgery vs SBRT for stage I NSCLC in patients who are candidates for both?
I agree with Dr. @Dr. First Last that it requires a very nuanced and personalized discussion. Our Yale approach (led by Frank Detterbeck) has been detailed in a 4-paper series in the Journal of Thoracic Disease 2022 (overview and SBRT/ablation focus), with the general paradigm balancing short-term, ...
What chest wall boost volume do you use for patients with inflammatory breast cancer?
I will typically boost the scar + 2-2.5 cm. It's also important to make sure the scar boost volume was all included in initial tangential volumes.
Would you offer partial breast radiation to a young breast cancer patient with BRCA 1 if all other criteria are met?
I would favor whole breast RT as the incidence of recurrence/new primary is high and there is data to suggest RT to whole breast reduces that incidence Evron et al., PMID 30475942