Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What SBRT dose do you recommend for an oligomet of the lung from prostate ca?
No reason not to go with standard >100 BED approaches (54/3, 48-50/4, 50/5, 60/8), as we don't necessarily have prospective data for prostate cancer specifically.
What dose/fractionation would you recommend for a large brainstem metastasis?
This is always a difficult clinical decision; for "large" (however one chooses to define this) pontine/medullary/brainstem mets, most have moved away from single fraction SRS to 3 fraction SRS (27 Gy in 9 fractions), based largely on the results of the Italian trial. In this trial, 289 patients with...
In a patient with an R1 resection of a chordoma who has declined proton therapy, what alternative radiation modality would you recommend?
Chordomas are aggressive and locally invasive tumors that commonly arise in the sacrum, skull base, or rarely the mobile spine. Resection is considered the first-line treatment; however, wide margins are difficult to achieve without significant morbidity. By nature of their site of origin near or ad...
Would you use triplet chemotherapy FLOT in lieu of chemoRT for patients with localized esophageal squamous cell carcinoma?
This is a timely question in esophageal SCC (ESCC), even as we adjust to the now markedly diminished role of pre-operative chemoradiation vs. FLOT in esophageal/GEJ adenocarcinoma, based on the recent phase III ESOPEC study [Hoeppner et al., ASCO 2024; LBA1] (as well as the NeoAEGIS study that prece...
Is whole body phototherapy for skin disorders a contraindication to chest wall or breast radiation?
I would not consider prior phototherapy a contraindication. I regularly treat patients with cutaneous lymphomas and occasionally, refractory dermatitis after phototherapy, mostly narrow band UVB. Some of them have received maintenance phototherapy for 1-2 years before treatment with significant skin...
Is a larger prostate size or volume associated with a higher absolute PSA bounce after radiation?
I have not seen anything in the literature to indicate that the magnitude of the PSA bounce is related to prostate size, but it's certainly possible. The highest bounces I have seen after treatment were in patients treated with LDR brachytherapy (my personal record is 8 ng/mL, and it eventually beca...
How do you treat adrenal metastases with SBRT?
Adrenal glands move quite a bit with breathing. I would strongly recommend some form of motion management, either with breath hold, or 4DCT with abdominal compression, (the latter of which is my personal preference). I draw GTV (just tumor, not entire adrenal gland) as defined on whatever imaging sh...
What is the best SBRT dose-fractionation scheme for oligometastatic disease in the adrenal gland?
I don't think we have established a true "best" SBRT dose-fractionation schedule for any anatomical site, even the common ones where we have randomized trials comparing different dose regimens (ie lung), as the volume of data provides successful and acceptable alternatives but not necessarily a defi...
Does the presence of LCIS on pathology in a patient with IDC impact your decision to offer APBI?
It doesn’t change the decisions for APBI with all other factors being favorable. We offer APBI to invasive lobular also if it meets all criteria and had MRI breast done as part of the evaluation.
How do you approach adjuvant therapy for resected lung adenocarcinoma that was found unexpectedly postop to be N2?
Preliminary results of the phase 3 randomized LungART trial (NCT00410683) were recently presented at a virtual ESMO conference. 501 patients with pathologically confirmed N2 NSCLC s/p complete resection were randomized to postoperative RT (54 Gy) or observation. Almost all patients received chemothe...