Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a dose to the lens that would be a contraindication for future cataract surgery?
I am not aware of any such dose limitation. Development of cataracts is not an acute process and consultation with an ophthalmologist would be the most appropriate course of action to determine when the surgery can be performed.
Would you treat the prostate in a patient with widely metastatic disease who has CR to all metastatic sites after systemic therapy or ADT?
This is an interesting hypothesis, but requires further study before offering. The trials that define a benefit to prostate RT in the metastatic setting (HORRAD, STAMPEDE, and now PEACE-1) did not use response-adapted selection criteria. Therefore, we cannot say that radiation to the prostate in an ...
For a patient with a lung tumor that is radiographically consistent with early-stage NSCLC but pathology with characteristics overlapping with upper GI origin, what additional diagnostic procedures would you consider before treating?
In the absence of imaging findings in a patient with a risk profile consistent with early-stage NSCLC, I would probably just move forward with definitive management as NSCLC with either surgical resection or SBRT as appropriate. The only other thing I would consider is to make sure they are up to da...
Would you offer RNI for young patient with cT3N0 triple negative breast cancer that had progression of disease during neoadjuvant chemotherapy, followed by mastectomy and sentinel node biopsy?
Yes, without hesitation. The primary randomized data suggesting an improvement in overall survival (OS) with PMRT in the T3N0 setting included RNI (e.g. Overgaard et al., PMID 9395428). There is also a study of +/- PMRT (including regional nodes) in T3 patients (about 40% of which were T3N0), that a...
With the current cisplatin and carboplatin shortages, for HPV+ H&N patients with indications for concurrent chemoRT, which agent do you recommend next?
The question of 2nd line therapy is difficult due to the dearth of data. This leaves essentially 3 choices - immunotherapy, cetuximab, or other cytotoxic agents.Regarding immunotherapy, recent trials for concurrent IO have been mixed, tending to compare IO vs Cetux. The main take-home though, is the...
When is it safe for a rectal biopsy in a patient with prior prostate radiation?
A biopsy of rectal tissue that has been radiated will have a higher risk of developing non-healing wounds and ulcers. Part of the reason that biopsies are discouraged as well as radiation proctitis is a clinical diagnosis and that biopsies of proctitis are certainly not needed to confirm this. Recta...
How do you proceed with radiation planning for preliminary suspected high grade gliomas after surgery when there is a delay in final molecular diagnosis?
While traditionally, for glioblastoma, we start post-operative radiation therapy within 4 weeks of surgery, recent reports (for example, from Israel) have shown better survival if radiation is started at 6 weeks, which should be sufficient time for molecular studies. If for whatever reason radiation...
What is the significance of LVSI in determining post-op management for oropharyngeal cancer?
It doesn’t change my management.
How do you approach contouring of the ITV for lung SBRT?
For tumors sitting in the middle of the lung and not near any other moving structures with similar Hounsfield units like mediastinum, larger vessels, chest wall, or diaphragm, then maximum intensity projection is a good place to start (verified with 4D video afterwards). If there is contact with oth...
For esophageal adenocarcinoma with extensive associated Barrett's, would you extend your CTV coverage beyond the usual expansions to cover the areas of known Barrett's?
The standard GTV to CTV expansions may include much of the Barrett's, but I would not deliberately target the Barrett's disease, whether treating with neoadjuvant or definitive intent. Chemoradiation is not a proven therapy for Barrett's disease, but treating a larger field will expose more heart an...