Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What cardiac surveillance would you do for an asymptomatic male patient with a remote history of mantle field radiation for Hodgkin's lymphoma?
I would follow the long-term follow-up guidelines from COG based on heart dose - Children's Oncology Group (survivorshipguidelines.org)
Would you cover regional nodes in an early-stage breast cancer with a non-mapping sentinel lymph node?
Based on the SSO Choosing Wisely Guidelines (https://www.surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdf) to not routinely use SLN biopsy in clinically node negative women ≥70 years of age with early stage hormone receptor positive, HER2 negative invasive breast canc...
Would you offer consolidative full dose chemo-RT for local residual pancreatic disease in a patient with stage IV pancreatic adenocarcinoma with excellent response after induction chemotherapy?
I think radiotherapy can selectively be considered in patients like this. The potential roles of radiation therapy could include: Palliation of local symptoms. RT is very effective at palliating symptoms such as pain related to celiac plexus infiltration, etc. Lawrence et al., Journal of Clinical O...
Would you compromise target coverage to meet OAR constraints for prostate radiation?
Median lobes can sometimes be challenging. There are a few options in this scenario. First, and most simply, ensure your bladder is comfortably full for simulation. Most IMRT bladder constraints are volumetric, so larger bladder sizes make meeting constraints easier. Second, if the median lobe is c...
When giving concurrent chemoradiation therapy, is it important that the infusion be prior to RT as opposed to after RT?
Radiobiological data suggest better cell kill when cisplatin is given before RT and then given after (1.7x vs. 1.2x) and similarly when delivered daily vs when delivered weekly. In practice, for that reason, we do it before RT and early in the week (Monday or Tuesday). The ongoing cervix OUTBACK tri...
Do you offer partial breast radiation in the absence of surgical clips?
Yes, as able to define surgical bed/seroma with a CT scan. If oncoplastic closure then there is no seroma/surgical bed to define without clips.
How are you approaching patients who receive neoadjuvant chemo immunotherapy for resectable NSCLC who after completion of neoadjuvant treatment are no longer surgical candidates due to factors such as toxicity, decline in PS, or patient preference?
This scenario seems to happen in 17-20% of patients. It’s very important to appropriately stage patients at diagnosis with PET CT, EBUS, etc to ensure accurate staging without which a good discussion regarding resectability is not possible. If a patient does, in spite of our due diligence, end up no...
How would you manage patients with exposed bone due to injured gingiva after recent chemoradiation?
Pentoxifylline and vitamin E
How would you approach treatment for a patient with locally advanced NSCLC and systemic scleroderma if chemoradiation is their only curative option?
My advice would be to provide some consent that there may be some increased risk of toxicity, especially esophageal, and then treat them as you would if they didn't have scleroderma. I think the literature suggesting scleroderma is contraindicated in radiotherapy is pretty soft. There's been some in...
What hotspot and heterogeneity metrics do you utilize when delivering PMRT to a patient who has had breast reconstruction?
I try to follow the same as intact breast. Limiting hot spot < 110 and V 105 < 5-10% and not hot spot in IM fold. Patel et al., PMID 30145393