Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When utilizing hypofractionation for postmastectomy radiation, what is your strategy for boosting undissected nodes?
2.5 x 4 to 5. Fractions based on the response of the undissected node to systemic treatment.
Given the 10-year outcomes of UK FAST-Forward presented at ESTRO, how have you expanded the use of ultra-hypofractionation in your practice?
We offer 5 fractions to all early-stage breast cancer patients. If technically suitable, the preferred option is APBI; otherwise, FAST-Forward 26 Gy in 5, ensuring dose homogeneity as specified in the protocol.
What volumetric dose constraints, if any, do you use for the mandible in the definitive setting for H&N cancers?
The planning directions for the mandible are typically <50 Gy. However, when the targets are adjacent to the mandible we do not constrain the maximal mandibular dose if it may compromise target dose. In that case, we plan a dose gradient across the mandible, with the mucosa and inner plate of the bo...
How would you treat a biopsy proven isolated left-sided internal mammary node recurrence 20 years after mastectomy and chemotherapy for left breast cancer?
A 20 year truly isolated IMN recurrence sounds like a pretty good example of an oligorecurrence to me… I think the historical standard of care is definitely as @Dr. First Last and @Dr. First Last have outlined above, but I wonder if it’s time to start viewing a locoregional breast oligorecurrence in...
When treating a low-lying and bulky cT2N0 rectal adenocarcinoma invading the anal sphincter muscles with neoadjuvant chemoRT for downstaging, would you electively include the inguinal lymph nodes?
Based on the paper that we published at MDAnderson in 1990, the inguinal recurrence rate is 2 to 5% if they are not treated electively in patients with tumors involving the anal canal. If the tumor is within 2 cm of the anal verge or right at the dentate line, it was 5%. If the tumor was between two...
When would you offer post-operative concurrent chemoradiation in anaplastic thyroid cancer?
The management of ATC has evolved considerably over recent years with the most significant being a dichotomy of management based on Braf mutation. We typically offer postoperative XRT, including in patients with either a limited or stable DM disease. However, in a multidisciplinary setting, there so...
Would you omit IMN coverage in cN1 TNBC with a CR after neoadjuvant chemo?
My practice has been to offer RNI in patients with cN1 disease with pCR in axilla outside of a trial. For TNBC in this situation, I would absolutely include IMNs in my RNI fields.
Would you consider using LDRT for joint pain/arthritis caused by aromatase inhibitors as a means to keep patients on therapy?
I would try this. I think there is an inflammatory component to this, and the subjective complaints appear to mimic OA. However, I do think this would be a wonderful group of patients to try this on. They are probably already comfortable with radiation, the achiness/discomfort from ET is real and we...
How do you approach ADT in patients with high-risk prostate cancer who have risk factors for VTE, such as Factor V Leiden?
My default recommendation for patients with localized, high-risk prostate cancer is to recommend the use of long-term ADT. This intervention seems to offer a relatively large, clinically significant OS benefit for patients in the modern era receiving dose-escalated ADT. This benefit has been observe...
What target volumes do you use for rectosigmoid/very superior rectal cancers?
The simple answer is that there should be a major alteration in treatment volumes in these patients, as there should be NO target volume as most of these patients with very high rectal/rectosigmoid tumors do not need to be irradiated at all. If one looks at failure patterns, the risk of local failur...