Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer adjuvant durvalumab for stage I small cell lung cancer following SBRT or surgery?
Obviously, there are no direct data, and the standard is EP chemotherapy. The cure rate in this situation is still suboptimal, but the majority of patients are cured. Adding IO might improve survival, but will most certainly increase cost and toxicity. I would discuss with patients, and I often tell...
What is your general approach to treating bleeding gastric masses with palliative RT?
We once had a patient with stage IV NHL who had transfusion-dependent bleeding from a pesky gastric mass that was chemo-resistant. It turned into a fatal complication, so it was presented as an educational case at ASTRO. We gave 4 Gy x 1 which stopped the bleeding within 24h, and switched to 3 Gy x ...
In what situations do you routinely use posterior axillary boost (PAB) for breast cancer radiotherapy?
The concept of the "PAB" is like the zombie that claws out of the ground every now and then (usually to haunt a resident who is getting ready to take the oral boards and is trying to memorize [cough!--irrelevant] bony landmark setup fields). Breast cancer radiotherapy is really idiosyncratic among s...
When do you recommend SRT, if ever, for small SCCs and BCCs?
SRT is a highly effective treatment for superficial radiation therapy. What is alarming is the use of daily US guidance for something we can visualize with our eyes. With electrons, I’ve never heard of anyone using image guidance. With SRT, the request for daily image guidance is routinely requested...
What is the significance of PNI in cutaneous BCC?
Not as bad as SCC. They rarely present with symptoms. That said, if it’s near a major CN, 5 or 7, add portRT.
Would having mucinous rectal adenocarcinoma impact your recommendation for short vs long course RT as part of a TNT regimen?
I would have no problem treating this case with five fractions of 5 Gy, followed ~2 weeks later with total neoadjuvant chemotherapy, followed by extirpative surgery; with the RT/surgical template similar to that of the investigational arm of the RAPIDO study (Bahadoer et al., PMID 33301740). Note t...
Should BED or EQD2 be used when deciding on a fractionation scheme for breast cancer radiation, and should tumor or normal tissue be prioritized in this consideration?
I feel, with many prospective randomized data, we are beyond looking at EQ2 dose for deciding fractionation. We follow the below rationale/pathway in our practice. Is biology suitable for PBI or not? (If suitable then plan for 30 Gy in 5 fractions like Italian data) Biology is suitable for PBI but ...
How long can a patient with newly diagnosed merkel cell carcinoma wait for wide local excision with sentinel node biopsy?
A recent study I read on this same question regarding sentinel node biopsy (SNB) performed after melanoma wide excision found that the sentinel node could still be found just fine. And I have found that in practice a number of times when I wide-excised obvious melanomas at first presentation visit. ...
Would you use SBRT to treat a lipoma of the spine that recurred twice after surgery?
Interesting question for an infrequent clinical matter. SBRT for recurring Lipoma of the spine, maybe - in my humble opinion.Related clinical questions -->>:1) Are the lesion(s) becoming more aggressive histologically?2) Are the lesion(s) becoming difficult anatomically for more surgery resections? ...
What are your current recommendations for treatment of symptomatic splenomegaly in the setting of myelofibrosis when splenectomy is not an option?
I use low dose, typically 50cGy per fraction for 4-6 fractions, done in 2 fractions per week; need to check platelets each week during course.