Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you consider elective pelvic nodal irradiation for unfavorable intermediate risk prostate cancer?
I consider elective pelvic nodal irradiation for patients classified as unfavorable intermediate risk by virtue of having Grade Group (GG) 3 disease, especially if they have high volume disease (50% or more of the cores are positive). These patients have a risk of lymph nodal involvement that is in ...
Would you offer PMRT to ER/PR+ patients with synchronous bone metastasis?
This is a more common scenario despite data suggesting a local survival benefit with the addition of local therapy to patients with metastatic breast cancer. With synchronous bone mets- we usually start with systemic therapy, ER+ would be endocrine therapy + CDK 4/6 inhibitor commonly. If stable/res...
Should rectal spacing only be considered routinely for patients who are at elevated risk of rectal toxicity?
I think some caution needs to be injected here (pun intended) before people decide to make a change in practice based on unpublished data. Let me remind everyone that the devil is in the details of the treatment technique, dose constraints, dose-fractionation schedule, treatment delivery technique, ...
Are there any factors which would lead you away from recommending active surveillance in low risk prostate cancer?
A healthy male with a BrCa mutation Or Any male with at least 50% + bxs Or The presence of Perineural invasion Or PSA density more then 0.30 may be a new indication after the AUA this year Would prompt a mpMRI and then fusion bx of any PiRADS 3,4 or 5 areas to rule out grade 4 pc
Is it appropriate to use electrons to treat a fibrosarcomatous DFSP of the face s/p R1 WLE?
If the geometry of the target volume is conducive to electrons, it is reasonable to consider. I might also consider use of a custom compensator such as: https://dotdecimal.com/products-proton-electron-or-photon-therapies/electrons-electron-treatment/bolusect-bolus-electron-conformal-therapy/
What is the best way to proceed in anal cancer surveillance if PET avidity of the primary is reduced, but still avid at time point <6 months s/p chemo-RT?
I would do serial physical exams every month or two and trust that more than PET-CT. If it continues to regress, then continue to follow. If after 6 months it has stopped regressing and you can feel something, can biopsy.
Would you change treatment approach for rectal cancer with an associated intussusception?
If the patient has obstruction, I probably would favor surgery first. If not, then I'd treat it as usual. It's a judgment call though.
Would you offer FAST-Forward for a metastatic breast cancer patient with breast implants needing palliation of symptomatic breast lesions?
This is a common scenario. If symptomatic and close to the surface/skin, I would favor 30/10-39/13 with 1 cm bolus to get skin dose where needed; I would be a bit concerned about 5.2 Gy/fraction and that amount of bolus. If larger, deeper lesions that are causing symptoms, 26/5 is fine in my opinion...
Does histology (e.g., lobular vs ductal) impact your decision to offer omission of RT to women with breast cancer who are otherwise candidates?
Histology doesn't influence me as long as IHC is favorable (although with 5 fraction RT, it is easier for patients to get to treatment than to observe).LCIS in specimen doesn't influence my decision as well.Although no tumor on ink is adequate for patients getting RT, that may not be true for the om...
For HPV-negative head and neck cancer of unknown primary after proper work up and biopsies, what mucosal surface(s) do you cover?
The treatment for CUP has evolved quite a bit, and frankly, I don't think there is a true standard. Even in our group, we often don't have consensus with regards to whether to even treat mucosa and if treating, which sites.Very weak data suggests that whether you just treat the involved neck or chas...