Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer breast conservation or PMRT (if clinically warranted) to someone with breast cancer in the context of Li Fraumeni syndrome?
I would be very reluctant as the benefit has to be weighed against the high risk of a second cancer that has been reported in limited published literature .
How do you approach treatment for isolated lung recurrences in patients that did not tolerate chemotherapy after lobectomy?
For non-small cell lung cancer recurrences after lobectomy I approach them the same way as a newly diagnosed NSCLC. If the lymph nodes are negative and the recurrence is small and away from the hilum and central structures, I would recommend SBRT, 50 Gy in 5 fractions. If the lymph nodes are negativ...
When treating with high tangents, do you use conventional fractionation or hypofractionation?
When treating level 1 and 2 nodes only we routinely use hypofractationation. Here is link to our approach http://www.sciencedirect.com/science/article/pii/S1879850017302072
How do you approach SRS for a brain metastasis in an eloquent area of the brain?
Short of metastases in the brainstem or next to the optic nerve/chiasm, we do not routinely decrease the dose or hypofractionate SRS in other eloquent areas such as the motor strip. While radiation necrosis is the main concern, the risk of recurrence which is shown to be higher with diminished doses...
Do you make any adjustments when treating cavitary lung lesions with SBRT?
Since the SBRT dose is already very high, we don't make any specific adjustments when treating cavitary lung lesions. The current modern RT planning system is accurate enough to take the cavitary into calculation consideration that is much better than pencil beam calculation algorithm. @Dr. First ...
Is it safe to use radioactive iodine therapy for patients with differentiated thyroid cancer and brain metastases?
Not all brain metastases from thyroid cancer accumulate radioactive iodine. It is not unsafe to use radioactive iodine in the presence of brain metastases, whether they have been treated with whole brain RT or SRS/SRT. If the brain metastases pick up radioactive iodine, there could be increased peri...
What factors would push you to consider using IMRT vs opposed lateral fields for a T2N0 glottic SCC?
I use IMRT for all. IMRT should not cause recurrence if done correctly.
What is your treatment approach to patients with extremity sarcoma with multiple positive regional nodes?
We generally include lymph nodes > 3 cm or multiple lymph nodes in the first echelon area if within a reasonable distance to the primary in the preoperative volume. For first echelon nodes at greater distances from the primary site without in transit involvement, we would separate out the primary CT...
How do you approach local therapy for oligoprogression of metastatic NSCLC?
Tsai et al. presented data from the CURB trial at ASTRO 2021. This showed a significant improvement in median PFS (44 vs 9 weeks) for NSCLC patients with oligoprogression (unlimited mets at presentation and 5 or less mets on progression) randomized to SBRT vs best supportive care. Interestingly, the...
Is there a volume limit above which you might not offer standard chemoradiation for a patient with a GBM?
I think this requires more information to answer. I presume the question is if there is a GBM that is of a certain size for which I may not offer standard chemoRT. There may be situations for which I may not offer standard 60 Gy in 30 fx IMRT and consider hypofx RT including older patients or patien...