Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of CNS prophylaxis in a healthy patient in their 60s with a large DLBCL of the cranium/dura with brain parenchymal invasion?
In general, the role of CNS prophylaxis designed to prevent CNS progression in aggressive B-cell lymphomas is controversial given that it has known toxicities (infections, cytopenias) without good data to support. We still do it at our institution for patients with biologically high-risk tumors, but...
Do you use bladder scans to assess fill prior to simulation and during treatment for patients receiving prostate radiation?
No. I have in the past and did not notice any difference, other than frustration from the patient and therapy team. My strategy - Sim at the approximate time of treatment (if tx time will be 9 am, try to sim at 9 am). When they get to the clinic for simulation, empty bladder as much as possible; t...
What dose and fractionation would you use for metastasis to the rectus muscle of the eye?
Breast carcinoma is the most common cause of metastasis to the orbit. Although overall rare, its incidence may be underreported, and up to 15-20% of presentations are bilateral. Multidisciplinary discussion is encouraged to rule out other potential causes on the differential diagnosis, such as MALT ...
How do you manage an inoperable T1b1 N1 M0 Cervix adenocarcinoma which developed 6 years after treatment of a rectal adenocarcinoma s/p LAR with adjuvant posterior pelvic radiation and chemotherapy?
There is no one answer but for central area, I would do brachy alone using IGBT with a dose of 7.5 Gy x 5 to HRCTV but aiming d98 GTV 95 Gy and above if possible based on rectal and bladder dosimetry.
Do you consider downstaging neoadjuvant cemiplimab for borderline resectable CSCC in order to facilitate surgical resection?
The answer is yes, since the publications of the neoadjuvant cemiplimab study in the NEJM (Gross et al., PMID 36094839/). However, this is a change of standard of care, not yet vetted in the NCCN guidelines (Guideline SCC4), nor FDA approved for this indication. Thus, off label cemiplimab or pembrol...
How would you approach radiation therapy for indolent T-cell lymphoproliferative disorder of the gastrointestinal tract?
Indolent T-cell lymphoproliferative disorder of the GI tract was a provisional entity in the 4th edition of the WHO classification system. In the 5th edition, the disease has been renamed, "Indolent T-cell lymphoma of the GI tract" (Alaggio et al., PMID 35732829). The disease is rare, often mimickin...
Would you be willing to give definitive chemo-radiation and chemotherapy to a MSI-stable T2N0 low lying rectal cancer in a young healthy patient who wants to avoid surgery?
More likely to recommend total neoadjuvant therapy hoping for induction of complete clinical response. In our hands, on average, we are able to conserve the rectum in about 55% of treated patients with excellent rectal function and a regrowth rate of less than 10%. Local excision will not address th...
Are you routinely using neoadjuvant cemiplimab for cutaneous squamous cell carcinoma of any site?
No
Do you treat the optional radcomp posterior lymph node field for patients with breast cancer?
I usually treat if medial supraclavicular node is involved, high nodal disease (10 or more) burden in the axilla, inflammatory breast cancer, or any PET avid node in the posterior triangle prior to chemo.
How do you manage dry eye related to Pluvicto Lu-177?
This is a real but uncommon side effect of Pluvicto therapy. Per VISION, it will happen in maybe 3% of patients but almost never high grade. Interestingly, the absorbed dose for the lacrimal glands is 2.1 Gy/Gbq - which over 6 cycles full dose at 7.4 GBq/200 mCi per cycle means 92 Gy. There was a me...