Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
If using hyperthermia in breast reirradiation, what type of protocol do you follow?
There are a few options we consider when using hyperthermia Hyperthermia and RT are given twice weekly, ex. 32-40 Gy/8-10 fx with hyperthermia Daily RT with twice weekly hyperthermia- 40/15, or 50/25 for example, with twice weekly hyperthermia. Sometimes consider concurrent capecitabine as well.
What is the role of local control +/- whole lung irradiation in a patient with relapsed/refractory Ewing sarcoma to the hilum plus multiple lung nodules?
I would boost residual thoracic disease to at least the usual Ewings gross disease dose of 55.8 (total, including WLI dose). Doses in this range are well known to be safe in the thorax and this multiply relapsed disease is likely to be more treatment refractory than primary disease. SBRT boost seems...
Is there any reason to hold fulvestrant during SBRT to an oligoprogressive nodule?
No.
For cervical cancer intracavitary brachytherapy, do you use contrast when using CT-based planning to better visualize the ureters?
We normally do MRI based planning and the ureter can be identified and contoured on MRI. For only CT based, we do out diluted contrast in bladder for bladder contouring but do not go to the ureter. Rodríguez-López et al., PMID 33065181Koerner et al., PMID 34980569
How do you prefer to manage multiple or numerous symptomatic skull metastases in a patient without brain metastases?
If it is painful, I would locate the areas that appear the most painful and "spot weld". I.e. - if there is a constellation of lesions on the right temple that can be encompassed with an electron field, I would treat that. Or, around vertex and can possibly do tangents. If there are virtually all o...
Is it reasonable to use hypofractionation in breast cancer patients with non-active connective tissue disorders?
Yes, it is reasonable to use hypofractionation in this patient panel. I have used the Canadian fractionation schedule several times in this scenario.
For a patient obtaining significant benefit and no side effects from pentoxifylline/Vitamin E for radiation-induced vulvovaginal fibrosis, do you continue treatment longer than 6-7 months or discontinue?
I reassess these patients at 3 and 6 months, regardless of site (gyn or breast). If the patient is benefitting from the trental/vitamin E but still has significant fibrosis, I continue these meds for up to 2 years.
What are your shift tolerances for fractionated SBRT and SRS treatments?
I generally use Shift more than PTV margin as an indication for repeat imaging.
Do you routinely boost the lumpectomy cavity for HER2-positive breast cancer in the absence of other risk factors?
I do tend to boost although absolute benefit for node negative favorable ER PR positive her2 neu positive breast cancer is probably minimal. For these patients, we also offer APBI routinely.
How would you treat a locally recurrent NSCLC abutting the heart that was previously treated with conventional chemoRT?
Like any reirradiation case, there is no one correct answer regarding this difficult scenario. The amount of time elapsed since prior RT, how much dose was received by the heart from the conventional treatment, cardiac/pulmonary comorbidities, life expectancy, performance status, other medical/surgi...