Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For meningiomas causing symptoms such as headaches, what percentage of patients experience improvement of symptoms after radiation alone?
Without question, patients are often found to have meningioma after presenting with headache. At times the headache may have been due to meningioma, particularly if the meningioma is large meningioma, has broad-based dural involvement, and/or is accompanied by edema, which they often are, especially...
How many missed fractions will you allow for a definitive lung CRT before recommending treatment on the weekend?
The clinical scenario posted in this question is not rare, since patient compliance or machine issues could result in missing fractions (i.e. treatment break) as originally planned & scheduled in a conventionally fractionated radiotherapy course (including definitive lung CRT that typically aims to ...
How would you treat a synchronous oropharyngeal cancer and proximal esophageal cancer?
After Dr. @Dr. First Last has set the tone for definitive chemo-RT that I totally agree, I would like to offer some additional thoughts: It is assumed that both synchronous primaries are anatomically separate and have been proven histologically distinct; e.g. the oropharyngeal primary being a SqCC ...
Is positive pleural fluid cytology from pleural mesothelioma considered M+?
No, positive pleural fluid cytology is not considered M1 disease based on AJCC 8th edition staging. Pleural effusion with positive cytology is often present even in early stage disease.Initially, MPM forms small, discrete nodules on the parietal pleura surfaces, convalescing into confluent sheets of...
How do we reconcile what appears to be a more aggressive surgical resection for DCIS than for invasive disease?
The guidelines panels did an outstanding job in generating both the DCIS and the invasive cancer margins guidelines. It needs to be recognized, however, that despite the sophisticated meta-analysis upon which the recommendations are based, the studies in the meta-analysis had limitations. Appropriat...
What is the recommended initial treatment for spinal cord compression due to non-Hodgkin lymphoma (e.g. diffuse large B-cell lymphoma)?
The answer depends greatly on clinical circumstances, such as stage of disease, degree of neurological impairment, prior treatment if any, etc. First, I would argue there is seldom a role for surgical intervention ( other then biopsy to establish diagnosis) since lymphomas are uniquely radiosensitiv...
Do you offer ultra-hypofractionated 5-fraction RT regimens for DCIS s/p lumpectomy?
The premise of this question attempts to "split" DCIS from early-stage invasive disease. When we live in an eternal present-tense, we naturally repeat the mistakes of the past. Again, as for modest hypofractionation, we are not going to see a "separate" clinical trial for pure DCIS in this space. In...
What regimen/constraints do you use for moderately hypofractionated salvage / post-prostatectomy radiation?
Current NCCN guidelines continue to recommend prescribed doses for adjuvant/salvage post-prostatectomy RT of between 64 and 72 Gy using standard fractionation. These regimens are known to be safe and effective. However, substantial non-randomized outcomes data from numerous institutions, including o...
For unresectable typical carcinoid, what is the appropriate radiation regimen?
I've treated a handful of these patients with SBRT, and we published a small case series, but to be honest, I'm not sure what to conclude about the efficacy. Historically it's difficult to draw any conclusions about the response of carcinoid tumors to radiation, whether it be fractionated or SBRT. T...
What are your top takeaways in Supportive Care from ASTRO 2024?
Keynote session: The Science of Bite-sized Well-being During Uncertain Times: Evidence, Practice and Resources to Share; Bryan Sexton, PhD This was a very interesting session, which could benefit not only attendees, but also members of our staff, and could lead to improved outcomes through a decreas...