Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What volumes and dose would you use for a chest wall recurrence in a patient who had previous mastectomy and completed only a partial prior course of PMRT?
I would treat it like a new course, provided cumulative brachial plexus dose constraints are met.
Is re-excision of residual disease ever itself an indication for PMRT?
This situation seems rather strange, but clearly the original surgery was inadequate, and re-excision still doesn't add up to optimal cancer surgery. Given these concerns, PMRT seems like a good idea. The fact that this is a right-sided lesion is helpful in avoiding cardiac RT in this young woman. T...
How would you utilize brachytherapy boost in addition to EBRT for HPV-dependent invasive squamous cell carcinoma present as a large pelvic side wall mass, presumed to be of cervix primary, albeit the negative biopsies of the cervix?
I have had one P16+ SCC of Unknown Primary that presented as a solitary pelvic sidewall mass/node, no FDG avidity outside of that region, who had a full gynecological evaluation. First things first, ensure a thorough anorectal evaluation to rule out an anal primary. I would treat with a focus on uni...
Would you consider omitting PMRT in cT3N0 triple negative breast cancer with a pCR?
These are challenging cases with limited data as Dr. @Dr. First Last notes. In a young patient with cT3N0 disease with a pCR, I would discuss the lack of data and that RT may reduce rates of LRR with unclear survival benefits. I would discuss the pros and cons but I would be comfortable offering the...
Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?
For extremities (e.g., the femur), if the pain is largely from structural instability, which resolves after surgical stabilization, then proceeding with systemic therapy without post-op RT would be very reasonable. On the other hand, if the patient is having persistent pain after surgery from the os...
What radiation doses and subsequent treatment monitoring would you recommend for multiple myeloma patients with multifocal bony lesions who decline chemotherapy?
Systemic therapy is the cornerstone of treatment for multiple myeloma, and the vast majority of patients initiate an appropriate regimen upon diagnosis. Occasionally, patients will have very limited disease and will be referred to Radiation Oncology for consideration of local therapy to delay the ne...
For epidural spinal cord compression in good-performance/prognosis patients who are otherwise inoperable, do you still aim for 30 Gy in 10 fractions, or are you fine with 20 Gy in 5 fractions?
In general, if prognosis is good (e.g., greater than roughly 6-12 months), 30 Gy in 10 fractions is preferred, given a lesser risk of recurrence with epidural spinal cord compression (ESCC) as compared to lower dose regimens such as 4 Gy x 5 in the longer term (e.g., from Rades et al., PMID 15908648...
Do you consent patients for diabetes insipidus following SRS or fractionated radiation for pituitary tumors?
This, and more broadly hypopituitarism of any type, is an important consideration and likely under-addressed topic in consent.Untreated hypopituitarism in adult life is associated with reduced all-cause life expectancy, and by one study 2x mortality rate compared with age/sex matched controls. [1]Th...
When do you recommend RT versus stenting for SVC syndrome in patients who cannot receive systemic therapy?
The option to stent upfront should always be considered before starting palliative treatment for SVC syndrome. Especially since it can offer reliable relief in a more timely manner. More importantly, it can at times avoid premature death in those in whom XRT might not work. However, it's critical to...
How do you explain progression free survival to patients?
This is a really, really important question. I'd argue we often greatly undervalue the importance of communication with our patients and the impact the quality of our communication has on what they understand about their illness. I remember once having a long conversation with a patient where I outl...