Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What scans do you order for follow-up in locally advanced non-small cell lung cancer patients who have completed definitive radiation with concurrent chemotherapy?
To my knowledge, there are no randomized studies that have examined the role and frequency of surveillance imaging in locally advanced NSCLC treated with chemoradiation. There is an ongoing randomized study looking at two follow up schedules in completely resected NSCLC (PMID 17519819).NCCN recommen...
Is ATM a contraindication to radiation therapy?
The data is limited with some concern about increased late efffects including fibrosis and increased risk of contralateral breast cancer caused by RT. I have not used this as absolute contraindication but discussed pros and cons with few patients I have treated and taken all measures to reduce contr...
For a localized hidradenocarcinoma of the extremity managed with resection, what adjuvant dose to the surgical bed would you recommend?
Hidradenocarcinoma is an extremely rare pathologic condition. Over the past five years I have treated many patients with hidradenitis suppurativa with surprisingly good results, but I have yet to see a malignancy arising in any of these areas. My advice would be to treat these patients as you would ...
What dose would you use to treat an unresectable axillary breast cancer recurrence in a patient who has not previously received radiation therapy?
I usually treat GTV node between 60-66 Gy based on volume of disease at the time of treatment ( some get upfront systemic treatment to downsize and make disease resectable and final dose is based on residual disease size )
Do you offer post-mastectomy radiation for invasive lobular carcinomas?
At present we use similar indication as invasive ductal cancer although more research needs to be done as there is suggestion of different response to antiestrogen therapy ( tamoxifen vs. AI) for lobular histology and most patinets have limited benefit from chemotherapy
How is your institution incorporating MRI planning into cervical EBRT/brachy?
Our department began utilizing MRI-based cervical brachytherapy in 2014. An MRI-based brachytherapy program is multi-disciplinary effort that required support from all departments, and it took about 6 months for us to implement. We have since progressed from MRI-based intracavitary only implants to ...
Would you wait to treat a ground glass opacity lesion (minimally invasive adenocarcinoma or adenocarcnioma in situ) with SBRT until there is more of a solid component?
In general, it is understood that the appropriate indication for utilizing lung SBRT is in the setting of a diagnosis of invasive cancer, i.e., early stage lung cancer or an oligometastatic lesion. With regard to ground glass opacities (GGOs) it is understood that the differential for these entities...
Do you counsel patients on the risk of dementia following androgen deprivation therapy for prostate cancer?
No, I generally do not counsel men about this risk. The two studies from the same investigator use a data warehouse search algorithm that may not be accurate enough to fully characterize who gets Alzheimer's disease or may not be able to correct for confounding factors that may be different between ...
What is the appropriate volume to re-irradiate in a recurrent GBM?
We need to recognize there is no standard dose fractionation regimen for re-irradiation in recurrent GBM. The volume and CTV/PTV margin are heavily depended on the dose/fraction you pick for your patients, and radiation techniques. The most commonly accepted regimen is probably 35 Gy in 10 fractions...
In a patient with brain metastasis confined to the cerebellum, would it be reasonable to treat the posterior fossa only (vs WBRT)?
If the patient has favorable prognostic factors and would like to avoid memory loss associated with WBRT, I would first consider whether the patient is eligible for stereotactic radiosurgery. If not a candidate for stereotactic radiosurgery, I would consider enrollment on eligible hippocampal avoida...