Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Which patients with DCIS can be observed following lumpectomy?
Based on ECOG and RTOG data, patients with small volume (less than 1 cm), grade 1 and 2 DCIS with no necrosis, and a good margin of excision (3mm or more) or those with definitive excision showing no disease have a smaller benefit with RT. After discussing the pros and cons and respecting the patien...
Is there a current 'standard of care' dose and fractionation in treating lung cancer with SBRT?
We have previously discussed the right BED dose equivalence for SBRT; one of the questions that is posed is which schema is "standard"? There is no one single standard scheme. We recommend that as an institution, you develop a process and scheme that works within your structure and workflow; we tend...
What kind of motion control do you use when treating lung cancer?
This is a multi-part question with answers depending on the specific goal and tumor being treated. In general, for advanced stage NSCLC being treated with definitive RT with conventional fractionation, I use shallow regular breathing with a chest mold immobilization device and 4D CT to quantify moti...
What do you consider is an acceptable surgical margin for invasive breast cancer?
It is a number where there is no consistency but nowadays for practical purposes, most people would consider no tumor at ink as negative margin. That being said, close margin in the presence of EIC or multiple close margins in young patients or significant tumor close to the margin (diffuse close ma...
Should we be more concerned about cardiac toxicity following breast radiotherapy?
The way I interpret the data with all caveats that threshold dose and time period for any cardiac morbidity is significantly lower than what was expected. For that reason, all efforts should be made to avoid any direct photon beam wherever possible to go through any portion of heart by using any one...
How much do you deflate a tissue expander prior to beginning post-mastectomy irradiation?
The need for deflation is based on your dosimetry and target volume. If we are not treating the IM nodes, then for most situations we don't deflate and we treat the chest wall with tangential beams. If we are planning to treat the IM nodes, then sometimes to get adequate coverage, the lung and heart...
What is the best imaging study to differentiate between recurrent glioblastoma and pseudoprogression?
Chemo-radiation-induced pseudoprogression (Psp) and/or necrosis present with MRI findings indistinguishable from tumor recurrence on conventional contrast-enhanced MRI. However, while early progressive disease (ePD) indicates treatment failure and necessitates a change in therapy, Psp indicate succe...
Do you include the dural tail when treating benign meningioma with SRS?
Usually not; it is not common for the dural tail to be directly involved by tumor; however, in some cases, one can visualize tumor approaching the dural tail as distinct from the vascular dural tail, in which case the tumor of course needs to be targeted
What is the biggest mistake people make when performing lung SBRT?
I'm not sure if it's the biggest mistake, but I have seen cases where there could be much steeper dose falloff outside the PTV if the planners had allowed for a hotter hotspot in the center of it. In cranial SRS the initial idea was to prescribe to the isodose line in the beam penumbra that covers t...
What is the role of a radiation oncologist in a nuclear disaster?
So I reside in NYC (NY), and following the various attacks on NYC, I decided to join the local NYCMRC - Medical Reserve Corps. It is operated by the NYC health department, and it meets quite frequently. I felt it was something to do to give back to the community I live in, and to be at the table and...