Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For patients with metachronous isolated oligometastatic cancer of gynecologic origin to the supraclavicular fossa, do you prefer standard fractionation therapy to cover the entire supraclav or SBRT to the involved nodes?
Have preferred treating the entire region with sib boost to node.
When future immunotherapy is anticipated, do you alter brain metastasis SRS dose, margin, fractionation, or other factors in an attempt to decrease the risk of symptomatic radionecrosis?
No, I do not alter my radiotherapy volumes or dose for either active or planned immunotherapy. Much of the current data with concurrent ICI and SRS is from small retrospective observational cohorts but in general, meta-analyses of concurrent PD-1/PD-L1 inhibitors with SRS have demonstrated improved ...
Would you offer whole-breast RT to a BRCA-positive patient who has multifocal recurrent disease after APBI?
Before considering re-irradiation, I would counsel this patient extensively that they should have a mastectomy in this situation given the BRCA2 positivity, and recurrence vs. new primary < 2 years after treatment with RT.If the patient absolutely refuses mastectomy, re-irradiation could be consider...
How do you approach a prostate cancer patient with oligomet disease on PSMA PET?
I think there is a spectrum of 'PSMA-PET Avid lesion suspicious for metastasis'. In some locations, such as ribs, I worry more about false positives. For lesions with PET avidity without CT correlate, I worry about false positives and may advocate for a biopsy if it will change the treatment plan. S...
When do you consider replanning patient if body contour is off on CBCT but PTV is aligned to prostate?
When reviewing the CBCT for a prostate case, I first look at the PTV. I make adjustments as necessary. Then, I look at the rectum. If anteriorly, it approximates what it looked like at simulation, I proceed with treatment. If it appears substantially off, I may consider having the patient come down ...
Do you recommend adjuvant radiation therapy for resected spine metastases in NSCLC with targetable mutations?
I would offer adjuvant RT. We have no data to guide us on whether targeted therapy alone would suffice. Moreover, given that the patient had resection, most likely there was some level of cord compression involved. Would hate for that to happen again after resection with suboptimal adjuvant therapy....
How would you treat bilateral synchronous breast cancer with single bony metastatic disease on imaging when one is ER+ HER2 neg and other is TNBC?
I will make some general statements, but lots of "depends" that you, the patient, and your team must discuss and decide. Firstly, it is important to biopsy this single site to determine which breast cancer has metastasized. It is also important to recognize that although you see "a single bony metas...
Would you consider re-irradiation for recurrence of Dupuytren's Contracture?
I have, in fact, re-treated one patient about two years after the first course because some nodules were progressing. I did a limited electron field with bolus to cover just the affected area and gave 200 x 10. Things seemed to stabilize after that. I would not treat a third time, however, but I hav...
How would you approach HDR portion of cervical SCC with large area of fistula with sigmoid colon?
Consider using ultrasound every time a tandem is inserted or a Smit sleeve placed under ultrasound guidance (if not already part of routine practice) for tandem guidance, to ensure that a false tract into the fistulous bowel is not produced at the time of tandem placement. Otherwise, as noted by Dr....
How do you approach external beam RT to the thyroid bed for resected recurrent thyroid cancer in a patient with previous history of 150mCi of radioactive iodine?
This is a terrific question and speaks to ALARA; I know of no data or dosimetric capacity to accurately estimate a biological effect (dose-wise) from an unsealed radiopharmaceutical on OAR. Keep in mind that dose limits for I-131 are due more on bone marrow toxicity than local effects. Previously, w...