Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you do immobilization for liver SBRT?
There are 2 components of internal organ motion to be concerned with: Inter-fraction motion and intra-fraction motion. Most people have good solutions for respiratory motion control and external immobilization (intra-fraction motion). It's difficult to compare between them because people only know t...
What features would make you consider covering elective nodes in a locally advanced, node negative paranasal sinus SCC?
Yes if >/= T3 or for max sinus involvement.
How do you incorporate NaF bone scan in the initial workup of prostate cancer?
At this point, I think the field is still learning how to make use of these tests and trying to determine which patients are the best candidates. We clearly need better imaging to detect early metastatic disease and lymph node involvement, as these findings would change how we would approach the pat...
How do you approach a patient with NSCLC and 3 oligometastatic lesions that are 4-5 cm in muscles of the extremities?
This is a great question which I suspect will lead to a wide range of answers. My thought is that if the indication is strong enough (which could be iffy as these are likely poor prognosis metastatic sites) that I would proceed with SBRT in this setting - the strongest factors in my decision of SBRT...
What is your strategy and evidence to use hyperthermia and/or chemotherapy with radiation for recurrent breast cancer?
When dealing with recurrent breast cancer and considering re-irradiation several factors need to be evaluated:1. Is the patient metastatic- deciding on local therapy for palliation or more aggressive treatment for local only recurrence2. How much previous dose and to what regions.I offer patients se...
Is there a role for PORT in a N1+ NSCLC patient who refuses chemotherapy after lobectomy?
A few caveats to consider - is the patient refusing adjuvant chemo, or are there competing risks (cardiac, age etc) that may attenuate the absolute benefit of adjuvant chemo?EGFR / ALK status ? PD-1/PD-L1 status? (there are adjuvant trials evaluating other systemic options)In the absence of other op...
Would you do SRS for a patient who cannot receive gadolinium contrast and has a single brain metastasis on non-contrast MRI?
There is a reasonable concern that other small brain metastasis could be present without obtaining fine cut T1 imaging with gadolinium contrast. As long as the patient is otherwise a reasonable candidate for radiosurgery, and can return for follow up, I would feel comfortable going ahead with SRS ba...
When a patient with stage IIIA NSCLC is treated with induction chemotherapy alone followed by surgery, and has a pCR, do you offer post-operative RT based on pre-chemo findings or omit due to complete response?
This issue comes up regularly....the assertion being that if the mediastinal disease has been cleared with chemotherapy, there is no need for RT. However, studies have shown that local failure is still quite high even when a mediastinal pCR is achieved. In the SAKK trial (B Journal of Cancer 2006;94...
What do you use for post-treatment follow up for prostate cancer patients whose cancers make little to no PSA, such as very high Gleason grade/neuroendocrine tumors?
We can probably separate the question into two categories: the rare prostate cancers that make absolutely no PSA and those that make relatively little PSA. For those that make zero PSA, then I've generally followed them with imaging similar to how one might follow a small cell cancer of any primary ...
How do you manage multifocal glioblastoma or high-grade gliomas?
In multifocal glioblastoma or high-grade gliomas, I would consider surgical resection if there was a dominant lesion or lesions causing symptoms. In cases where debulking is unlikely to provide symptomatic relief or aggressive surgery is most likely to remove a portion of disease burden, I would ten...