Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer adjuvant radiotherapy to a young patient with microinvasive lobular carcinoma (< 1 mm) in a background of LCIS?
I would favor RT as part of BCS but would also like to know the LCIS type (pleomorphic or not) to better quantify the risk of IBTR.
What dose constraint do you use for the spinal cord and/or cauda equina for a spinal meningioma?
Presumably WHO 1. 50.4/28 fractions. Good control. Low risk of injury.
How do you time PET/CT surveillance and COVID boosters?
I have not changed the timing of PET surveillance imaging around vaccinations but 1) is a frequent question from patients, and 2) I have seen a fair amount of false positive FDG avid axillary adenopathy post-vaccination. Think this tends to be too unpredictable in the duration of these imaging findi...
What approach do you take to determine dose constraints for SBRT reirradiation of the head and neck?
There is likely no "safe" dose when delivering full-dose SBRT overlapping tissue that previously received 40-70 Gy. The best you can do is make sure the patient understands the risks, that this strategy fits their goals of care, that you've considered all alternatives, and that you approach planning...
When starting HN radiation, which start day do you prefer to add most value to the treatment course?
Not sure there is really strong data on the preferred day to start. With a 35 conventional fraction HN plan, starting on a Monday ends on a Friday (assuming no holidays or missed treatments). With the same assumptions, starting on a Tuesday ends on a Monday, etc. So personally, haven't been dogmatic...
What is the role for molecular agents alone for medically inoperable NSCLC who is not a good candidate for chemoRT?
If medically inoperable and deemed not a chemo candidate, my preference would be definitive RT alone using a hypofractionated approach to account for the absence of radiosensitizing chemotherapy even for patients with targetable driver mutations. The best data we currently have would then say to con...
Do you recommend PMRT and if so, do you treat the regional nodes, in patients who are cT4N0 (non-inflammatory) treated with neoadjuvant chemotherapy who have a pCR at the time of mastectomy?
I would recommend PMRT and treat chest wall and regional node comprehensively. At present those who present with clinical stage III disease like above and have pCR we recommend PMRT. Some of them are suitable for B51 also (stage III and node positive upfront converted to node negative) and we do off...
What is your preferred palliative radiation regimen for patients with painful bone metastasis?
Because of the great work of the BM Working Group led by Hartsell et al, and the Dutch, for examples, there are ample category 1 data supporting the use of Single Fraction (800cGyx1) EBRT for "uncomplicated" bone lesions. That is, the use of 800cGy x1 unless there is: a soft tissue component, an imp...
Do you do urethrogram at time of prostate simulation?
We don't perform a urethrogam. We do MRI with a pelvic coil and fuse it with the CT scan which helps to identify the base, lateral edge and apex appropriately.
In what settings do you routinely image the spine for work-up of an intracranial glioma?
I do not routinely image the spine following workup of an intracranial glioma. It is not because they are not common because in fact, it can be found in 25% of patients with supratentorial glioblastoma (Kaloshi et al. Acta Inform Med 2014). Rather, symptomatic spinal dissemination occurs in less tha...