Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend breast MRI for patients with invasive lobular breast cancer considering breast conservation therapy?
I agree with @Dr. First Last. I used to get MRIs in women with lobular cancers routinely, but as data have shown no outcome benefit to pre-op MRI and a higher mastectomy rate associated with the use of MRI, I now only get MRIs in patients in whom the surgeon feels that the other imaging is too equiv...
Do you ever consider treating the axilla in patients with multiple nodes with ITCs?
Agree with above. IHC is considered node negative by definition. No further axillary treatment is required.
What is the standard RT dose in locally advanced NSCLC with concurrent chemotherapy?
I have an opinion on this topic....several opinions actually! The paper is coming out soon. We included a tremendous amount of data. I hope you will read through it in your journal clubs. I agree with @Dr. First Last that the results of RTOG 0617 were a 'kick in the gut'. They were (and are) certain...
In Stage I-II primary mediastinal B-cell lymphoma (PMBL), bulky or non-bulky, is post-chemotherapy radiotherapy still standard in patients with a complete response to CHOP-R chemotherapy?
Primary mediastinal B-cell lymphoma (PMBCL) is a rare subtype of DLBCL. It is a clinicopathologic entity by WHO criteria (which makes it occasionally difficult to conclusively diagnose). The typical patient is young, female, with a large, anterior mediastinal mass. The optimal therapy for PMBCL is c...
What's it like to be a radiation oncologist at a Veterans Affairs hospital?
Leland, a collegue here at Richmond, said it well. I’m inspired each day. While cancer can be scary, many Veterans have faced death before. Our patients have an incredibly high level of resilience and trust in the system. Many are dual beneficiaries, with both VA and Medicare benefits, but prefer to...
Is post mastectomy radiation therapy indicated based only on pre chemo MRI and PET CT positive axillary lymphadenopathy, if surgery following neoadjuvant chemo showed CR ?
These patients are eligible for NRG-B51 to try to attempt to address this issue. My view on the trial is that observation is the experimental arm and radiation is the standard arm, so off trial I generally would offer post-mastectomy radiation, though there is room for flexibility depending on other...
Can a second course of SRS be used to treat a brain met that initially responded to SRS and then progressed?
One should use caution in interpreting imaging as a definitive sign of progression, as sometimes radiation necrosis can mimic those findings. if asymptomatic, the patient can be considered for close observation with imaging and if symptomatic, one should consider a surgical option also.
Regarding regional nodal irradiation for triple positive breast cancers, how much do you weigh in the availability of effective adjuvant systemic therapies (i.e, hormonal and anti-Her2 therapy) in theory being able to control subclinical nodal disease without the need for RT consolidation?
Some of these questions are unanswered, as systemic therapy has changed for the subset of breast cancer who are suitable for targeted therapy. That being said, with improved systemic treatment, the absolute benefit of RT may be small but this improved locoregional control may have a higher impact on...
When using short course fractionation for an elderly patient with glioblastoma (40 Gy in 15 fractions), what are appropriate dose constraints for chiasm, brainstem, optic nerves?
Dose constraints for normal tissues were not published in the randomized trial by Roa et al. of 40 Gy in 15 fractions vs. 60 Gy in 30 fractions for elderly patients with glioblastoma (Journal of Clinical Oncology, 2004). Given the apparent similar efficacy and tolerability of the hypofractionated an...
Is it preferable to offer hypofractionated SRT over single fraction SRS for brain metastases?
For bulkier lesions, or somewhat bulky lesions in bad locations (i.e. brainstem) I much prefer to use a 3-fraction approach, with admittedly less data to support it. We do, however, know that necrosis risks become significant with tissue V12 (single fraction) of >10-20 ml, so for patients with bulky...