Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with a mid-esophageal squamous cell carcinoma with tracheal invasion confirmed on bronchoscopy, would you treat with definitive chemo-radiation with curative intent?
I generally start with chemotherapy alone in these patients, usually carbo/taxol for 2-3 months, and then re-evaluate with PET, bronchoscopy, and endoscopy to determine if there is still evidence of transmural invasion into the trachea. Often, if the tumor responds, the tracheal invasion is no longe...
How long after resection for brain metastasis do you wait to request a radiation planning MRI?
This is a good question, and I agree with the sentiments above. I think there are two competing issues here--1) evolution of the cavity and 2) regrowth of microscopic disease.While intuitively, one might think that waiting longer might allow the brain to normalize and the cavity to shrink, our data ...
How do you approach the treatment of LS-SCLC after SBRT for a prior NSCLC in the ipsilateral lung?
You know, it was so rare to see this in the first half of my career, and now I see it a few times a year. It's a testament to the improvements we are seeing in the care of lung cancer patients... they are getting 2nd cancers. Where I am (Mayo), we generally treat it exactly like an SCLC from the per...
Is there a role for quad-shot or similar regimen in a patient with a technically resectable, but medically inoperable colon cancer that is both bleeding and causing a partial obstruction?
I do not use quad shot for the palliation of gastrointestinal tumors. I do not believe in giving doses larger than 3 Gy per fraction because it uses up tolerance, and it's difficult to retreat. My strategy is to be able to treat the patient again after recovery of tolerance in a year. This usually r...
Is keratosis follicularis (Darier disease) a contraindication to the receipt of PMRT?
Thanks for this interesting question. It prompted me to do a bit of literature search and think about how I'd approach this case.For a postmenopausal patient with ER-negative, PR-negative, HER2-negative (triple-negative) pT2N0(sn) breast cancer and unresectable positive surgical margins after mastec...
What are your institutions' preferences on SBRT vs. histotripsy for treatment of liver metastases?
I'll avoid the institutional political discussion of competing modalities. Like many ablative modalities, there is limited data directly comparing the safety and effectiveness of SBRT. As the new kid on the block, histotripsy has no comparative data that I'm aware of with existing modalities.HistoSo...
What is an acceptable maximum "bridging" dose between SRS/SRT targeted brain metastases in close proximity to one another?
Hi @Dr. First Last, hello from your neighbor in Flint, I hope this helps: I use "Brain Minus GTV" as my normal brain OAR, and to reduce the risk of radiation necrosis/edema, I try to keep it under: V12 at 5 cc or less for single fraction SRS; above that I will fractionate V28.8 at 7 cc or less when ...
Are there patient populations in whom you would consider using both induction chemotherapy and maintenance pembrolizumab for a patient with locally advanced cervical cancer?
Would consider for patients with multiple pelvic and high pa bulky nodes where risk of distant mets is extremely high, with the goal to treat with systemic intent, and if good response and no mets, proceed to definitive chemo-RT.
In patients with concomitantly diagnosed stage IV DLBCL and gastric MALT lymphoma who have residual gastric MALT after 6 cycles of Pola-R-CHP, would you alter the standard dose/fractionation for ISRT for the gastric MALT lymphoma?
Chemoimmunotherapy, while potentially curable for aggressive non-Hodgkin lymphomas such as DLBCL, is not generally considered a curative treatment for low-grade histologies, such as follicular and marginal zone lymphoma. After completing appropriate therapy for the more aggressive histology (DLBCL),...
What radiation fields would you recommend in a young patient with luminal B histology and ITCs in a single sentinel node?
I would not change the RT field, which could be APBI or whole breast, based on technical and biological factors (presuming this is upfront ITC).