Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can the SIB regimen from RTOG 1005 be extrapolated to all patients requiring whole breast irradiation?
In principle, anyone who would benefit from boost could be treated with either RTOG 1005 or IMPORT HIGH regimen of SIB.
Have you ever used a "Quad Shot" regimen or other fractionation for patients with uncontrolled inguinal nodal disease?
Yes, we do for palliation like any other pelvic malignancies.
What dose/fractionation do you use for spine schwannoma?
50.4/28 fx
For a small focally positive DCIS margin in the setting of invasive disease and negative invasive margins, not undergoing re-excision, what boost dose would you use?
Yes. I would give a higher boost dose in the setting of a positive margin. In the old days, at 2 Gy per fraction, I would tx positive margins to a total of 66 Gy, and this usually worked out well. Occasionally, the patient would get some telangiectasias long-term. With Canadian hypofraction, I have ...
Do you routinely treat oligoprogressive metastatic sites with SBRT in patients receiving systemic therapy and otherwise stable disease?
I am often referred patients who have oligoprogressive disease in the context of widely metastatic disease that is responding to systemic therapy, particularly targeted therapies. These patients have often been on these therapies for at least a year and generally have good performance status. The de...
In asymptomatic patients with unfavorable intermediate risk prostate cancer and a PSA <10, how helpful/reliable and clinically useful is bone imaging?
Bone scans amazingly are still something we discuss, and I imagine when we look back in 5 years at this question (at least I hope), people would think it is unthinkable to order a bone scan for intermediate risk with PSA <10 (let alone in localized PCa) instead of MRI and/or PSMA PET/CT.10 years ago...
How will the PROSPECT trial presented at ASCO 2023 change your current management of early rectal cancer?
I can’t overstate how much credit the Principal Investigator, Dr. @Dr. First Last, deserves for successfully completing the PROSPECT trial. The oncology community, particularly the radiation oncology community, was concerned that omitting radiation would put patients at risk. It was difficult and ch...
What radiation dose constraints should be used for the spinal cord in pediatrics?
As part of the PENTEC project (Constine et al., PMID 37999712), I had the privilege of finding all of the cases of pediatric radiation myelitis in the literature. This is modified from our published findings, I encourage you to read the full manuscript if you would like further details (Cooper et al...
For anal radiation dermatitis, does anyone have experience with 3M Cavilon protectant?
I've used it a couple of times. It is most useful for those with a lot of discharge, incontinence, and chronic moisture. In those patients treating early with an antifungal agent and using barrier protection cream like cavilon can be helpful. That said, it is not clear to me that Cavilon is better t...
Can patients receive adjuvant radiation therapy after keloid excision without primary closure, or would radiation impede healing by secondary intention?
I have personally treated several patients where primary closure was not obtained due to the large size of the keloid (back and anterior mid-chest). Due to the limitation of raising a large flap around these regions to close the wound primarily and poor take rates of a skin flap, these resections we...