Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the largest non-spine bone metastasis you would be willing to treat with SBRT?
The size or volume per se is not a limiting factor for SBRT. Doses to OAR (parallel and serial organs) are the most important factor. I have treated large bone metastases with ablative radiotherapy (SBRT or hypofractionated IGRT) without issues.
For breast cancer patients s/p IORT with pathologic features indicating that follow-up whole breast radiation is needed, is the current standard of care to use conventional fractionation or are there data to support hypofractionation?
I have used 40 Gy in 15 fraction, as the equivalent dose is less than 50 Gy in 25 fraction, and thus we don’t expect a significant difference in outcome.
Is there a role for definitive radiation in a patient with vaginal melanoma who is not a surgical candidate?
Yes, for local control and preventing symptomatology. I use a combination of EBRT and brachy, with the type of brachy based on the response to EBRT. Some patients do have a complete response, although the risk of distant metastasis is very high.
Do you treat regional nodes for node negative (by SLN) patients with early stage breast cancer in a medial location?
High grade. Triple neg.
How would you manage a high risk SCC of the scalp that has wound healing issues after Mohs surgery?
Refer the patient to plastic surgeon for wound repair. Indicate that the cancer is high risk for recurrence and warrants adjuvant RT (sooner rather than later), and that a vascularized reconstruction is preferable for that reason. In our experience, 60 Gy in 30 fractions is effective to prevent loca...
How would you treat a T4 rectal cancer invading the uterus that is causing rectal and vaginal bleeding?
In this T4b locally advanced rectal cancer, I would recommend neoadjuvant chemoradiation (RT dose 45 Gy to the pelvis +/- boost to 54 Gy to the gross tumor), followed by surgery (including a hysterectomy). The bleeding should stop in the first 2 weeks of neoadjuvant therapy. You do, however, have to...
How do you sequence ADT relative to radiation for a low volume M1 prostate cancer?
Start with radiotherapy, carry on hormone therapy for up to two years.
What radiation approach would you use for a young patient with locally advanced Her2+ breast cancer, with complete metabolic response after neoadjuvant chemotherapy who refuses surgery?
We are in a data free zone here, and all effort should be made to encourage the patient to undergo surgery, and not compromise on survival.
How do you evaluate and constrain the cumulative lung DVH for inoperable patients who have received multiple courses of lung SBRT and now require fractionated mediastinal RT?
This is an increasingly common problem and there are few data to guide decision making.However, some have looked at dosimetric-toxicity relationships in the reirradiation setting (either re-SABR or conventional radiation after SABR).It's suggested that composite high dose to a previously irradiated ...
Do you do a CT simulation for post op heterotopic ossification prophylaxis?
Yes, we treat a fair amount of HO cases at our institution in NJ, and in most cases, at least that I know of, we have always obtained CTs for planning. Honestly, because the anatomy is so straightforward in the hip area to be treated, just plain 2D imaging will suffice. In the old school way, we use...