Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach reirradiation in a patient who underwent breast-conserving surgery for recurrent breast cancer after initial lumpectomy and APBI?
There is very little data on this scenario, though with increasing numbers of patients opting for partial breast radiation, this will become a more common issue going forward. While mastectomy remains a standard option, many women will desire breast preservation, and we have seen several women treat...
Have the 10-year results from UK FAST-Forward presented at ESTRO 2025 impacted your practice with regard to patient selection?
I would consider our practice at Mayo as early adopters of ultra-hypofractionation for breast, largely driven by similar institutional trials for shorter courses and the patients we care for. As a result, we have pretty routinely offered 26 Gy/5 fraction whole breast RT since the 5-year follow-up wa...
In what circumstances would you offer axillary re-irradiation after salvage axillary dissection?
A study from many years ago found no further axillary recurrences in 4 patients who had gross total excision of axillary recurrences following initial breast-conserving therapy, including RT and axillary dissection, with a median follow-up of 28 months (Recht et al., PMID 2033433). However, there is...
Do you routinely offer PMRT for T3N0 breast cancer?
Yes, especially in young women. The Danish PMRT trial included T3N0 patients, and in the pre-menopausal group, there was a meaningful increase in overall survival (10-year actuarial survival 82% vs 70%, with vs without PMRT; Overgaard et al., PMID 9395428). Now, one can argue that this is an old ...
Is there data to support treating postoperative endometrial pelvic EBRT with a daily dilator in the vaginal canal?
Data is more for GI malignancies on using a vaginal dilator to reduce dose to the anterior vaginal wall and thus the risk of stenosis. With the vagina being a target for endometrial cancer, there is no study using it during RT to show any benefit.Arzola et al., PMID 37898354
What are some considerations for planning T&O brachytherapy in a patient with bilateral hip replacements, where it is difficult to delineate disease on MRI and even surrounding structures on CT?
I have favored MRI-based contouring and planning in these patients. Dual-energy CT or simulation metal artifact reduction software can also help with better delineation and planning.
What would be your radiation boost technique and dose levels for adjuvant treatment of endometrial cancer with high-grade disease or aggressive histology if there was a positive margin at the parametrium after TAH+BSO?
I usually consider 50.4 Gy with EBRT followed by an additional 5.4 Gy to the parametrial region. Whether this additional boost helps is not known.
When discussing definitive prostate radiation, how do you respond to patients who mention that they heard that surgery is more difficult after radiation treatment?
I love this question! I hear it quite often, and it provides an opportunity to discuss the differences between radiation and prostatectomy, and the potential benefits and risks of both. I start by stating that it is absolutely true that radiation causes scar tissue that can make surgery months to y...
In pediatric patients with Hodgkin lymphoma who have a partial response after chemotherapy and multiple disease sites above and below the diaphragm, how do you approach radiotherapy planning considering cumulative dose and toxicity?
RT dose and target volume in pediatric Hodgkin lymphoma are determined according to the systemic therapy protocol being used. For example, your case suggests a patient with Stage III or IV disease. In the COG study AHOD1331, patients received either Bv-AVE-PC or ABVE-PC systemic therapy x 5 cycles a...
What areas do you treat with RT for an intermediate or high risk pediatric Hodgkin Lymphoma with a slow early response?
For pediatric Hodgkin lymphoma, radiation fields are really based according to the treatment protocol. If the patient was being treated per AHOD 0031, then the radiation fields would include all sites of initial involvement, assuming they don't meet the criteria for omission of RT (RER and then a CR...