Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you prefer SBRT or fractionated radiation for a sacral peripheral nerve sheath tumor?
For a sacral peripheral nerve sheath tumor, I would favor SBRT (Stereotactic Body Radiation Therapy) over fractionated radiation due to its ability to deliver a high dose of radiation precisely to the tumor while minimizing damage to surrounding healthy tissues, especially in a sensitive area like t...
Under what circumstances would you consider omitting radiation in patients with early stage, unfavorable (bulky) Hodgkin Lymphoma?
We should first acknowledge that combined modality therapy improves progression-free survival in early-stage HL compared with chemotherapy alone. Stated more succinctly- if you give combined modality therapy, there is a lower risk of relapse; if you give chemotherapy alone, there is a higher risk of...
When treating inguinal lymph nodes in the setting of pelvic RT, what is your preferred setup in order to minimize dose to the penis?
I have tried a variety of different setups but have found that building a scrotal shelf works the best. The patient is set up supine in the frog leg position using your immobilization method of choice. I then use a custom moldable headrest and place it against the perineum to serve as a shelf for th...
What is your approach to a patient with incidentally found DCIS or invasive disease after a breast reduction?
Typically, in these cases I will give standard whole breast irradiation (40/15). I have not boosted as it's often unclear where the boost target is.
Can radiation to the breast be given in the setting of prior radiation for Hodgkin's lymphoma?
Based on previous dose and volume (as most people are getting ISRT and between 20-30 Gy), either whole breast or partial breast RT are usually options. One concern I have is the increase IBTR which is most likely new primary in these patients because of prior RT exposure (akin to BRCA mutation).
After the results of RTOG 0232, would you be comfortable treating unfavorable intermediate risk prostate cancer with brachytherapy monotherapy?
I would not necessarily be comfortable treating every unfavorable intermediate risk (UIR) patient with LDR brachytherapy alone (nor with HDR brachy alone). My reason for this is that 0232 only included about 50 patients in each arm with Grade Group 3 tumors, and no information is available about per...
Why do the most recent NCCN guidelines (Version 4.2024, 05/17/24) omit the duration of ADT for high-risk prostate cancer patients?
No idea, but version 1.2025 (accessed 12/10/2024) now includes ADT duration for high-risk, which is 12-36 months, with notes indicating, "For high-risk and very-high-risk prostate cancer treated with combination EBRT brachytherapy, a shortened duration of ADT (12 months) can be considered." For high...
Would you include the entire bladder in the treatment field of a patient with a history of T1 bladder cancer s/p intravesical therapy who is now being planned for chemoradiation for a T3N1 rectal cancer?
No, I would NOT include the entire bladder in the treatment field. The major driving factor for his survivorship will be rectal cancer (instead of bladder cancer) in his case. Given that his superficial bladder cancer is relapse-free for 2 years, his outlook from a bladder cancer perspective is favo...
What normal tissue dose constraints do you use when delivering up to 3 cycles of the palliative quad shot regimen for gynecologic pelvic malignancies?
I don’t follow fixed dose constraints but adjust based on the volume of disease and the volume to treat.
Is it ever reasonable to offer EBRT alone for a patient with high risk prostate cancer?
I think there could be 3 broad reasons to consider not combining RT with ADT for high risk prostate cancer: Disease risk: If a patient falls into a more favorable part of the high risk spectrum (e.g. high risk by PSA only, MRI without ECE/SVI/LNI/larger nodule size, or perhaps lower-risk genomic cla...