Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider a FAST-forward fractionation for a cT1a IDC with DCIS that was found to be pTis on lumpectomy specimen?
I do consider FAST-Forward for patients > 50 years old following breast conservation. In this situation given invasive disease, I am comfortable with no tumor on ink even with associated DCIS.However, if otherwise acceptable, I would offer this patient PBI (30/5) rather than FAST-Forward. If for som...
How do you define treatment volumes for patients treated with neoadjuvant chemoimmunotherapy for resectable NSCLC who are no longer surgical candidates or decline surgery?
Good question and seeing this more routinely as there is a greater push for a neoadjuvant approach in borderline resectable surgical patients. We don't have patterns of failure data to guide this but I use the same principle/approach I use for LS-SCLC that I'm initiating at C2. Post-chemo/IO primary...
When considering re-irradiation of a critical organ, should EQD2 or BED be utilized?
EQD2 and BED are essentially interchangeable. I prefer EQD2 since it conceptually makes more sense to me.BED = D x [1 + d/(α/β)]EQD2 = D × [(d + α/β)/(2 + α/β)] = D x [1 + d/(α/β)]/(1 + 2/α/β) = BED/(1 + 2/α/β)The more challenging questions (that I do not have the answer to!) are as follows: How do ...
How would you manage a patient with a negative axillary ultrasound but no sentinel lymph node evaluation at the time of lumpectomy for early-stage breast cancer?
If the patient meets PRIME criteria, one can do either APBI or FAST-Forward, based on the preference of the patient. If doesn’t meet PRIME criteria, favor a whole breast like the SOUND study.
What dose would you consider for a patient who received 59.4 Gy 18 years ago for a glioma of the right frontal lobe who is now S/P gross total resection for a high-grade glioma in the same area?
Given that the patient was treated 18 years ago and has undergone GTR, I would be more inclined to treat to the full dose using standard fractionation; 54-59.4 Gy in 30-33 fractions (depending on molecular features). I would treat with concurrent bevacizumab in addition to any other systemic therapy...
Is it acceptable to give hypofractionated breast radiation in a patient who is being treated for rheumatoid arthritis with Actemra, methotrexate and leucovorin?
I don’t think fractionation makes a difference to toxicity as long as dose homogeneity is met.
How do you reconcile the differences between 2022 ABS APBI recommendations and 2023 ASTRO APBI recommendations?
Some of the differences arise not due to negative data but rather from insufficient data or representation in clinical trials. For instance, lobular histology, which in the MRI era, has a high negative predictive value for multifocality/centricity.
What ENI/lymph node stations would you treat for a locally advanced SCC of the thumb?
Axilla is most likely, and then epitrochlear fossa.
In oral cavity cancers, how does WPOI (worse pattern of invasion) influence your decision to offer adjuvant therapy?
It doesn’t.
How do you advise a patient on ozone therapy?
I’d advise against it.