Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend placement of a rectal spacer when delivering radiotherapy to the prostate in patients with oligometastatic prostate cancer?
No. I have had a few patients seek it out on their own, which is fine. But I tell them it is not necessary.
What dose constraints do you use when treating a patient with bilateral breast cancer with RNI?
This article highlights lung, heart, esophagus, and dose homogeneity constraints we aim for when treating bilateral breast cancer and RNI. Li et al., PMID 41272934
How do you treat a large basal cell carcinoma involving the dorsum and entire tip of the nose when brachytherapy and orthovoltage are not feasible?
Hard to know without seeing, but likely create 3D bolus and treat with electrons. Can also potentially do IMRT/VMAT with photons, likely more homogeneous dose distribution, but I typically favor electrons just based on comfort.
When offering palliative radiation for breast cancer, what dose/fractionation do you prefer and in what subset of patients do you believe derive the most benefit?
More recently after FAST-Forward, use 26 Gy in 5 for palliation as shorter and reasonable dose to palliate pain, bleeding, and drainage.
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.
Does an esophageal stent impact your radiation treatment plan for a patient with non-metastatic GE junction adenocarcinoma?
While the presence of a stent might not directly affect my radiation dose and volumes, due to numerous other considerations, it would certainly affect my overall treatment plan. I highly encourage avoiding a stent in the setting of radiation due to toxicity concerns in addition to the complications ...
What radiation treatment volume would you include in chemoradiation given for perihilar lymph node recurrence after surgical resection and mediastinal lymph node dissection for NSCLC?
I typically ask for a PET-CT, MRI brain, and comprehensive EBUS. If isolated to the hilar LN, I would just cover that region and not any elective nodes.
Would involved site radiation therapy be recommended in a patient with POEMS syndrome whose myelopathy symptoms worsened after one cycle of CyBorD?
I would swiftly treat this patient with a common schedule, for instance, 5 x 4 Gy. I do not see any risk of concurrent rituximab.
Would you utilize splenic radiation for patients with non-myeloid malignancy and splenomegaly in the setting of platelet sequestration, which is limiting cytotoxic systemic therapy options?
I am not sure if I understand your question correctly. However, if splenomegaly is not associated with a) lymphoma infiltration of the spleen or b) ectopic hematopoiesis in the spleen, then spleen irradiation will not help.
Would you consider omitting concurrent chemoradiation for a patient with stage III EGFR-mutant NSCLC and initiating treatment with osimertinib instead?
No. Osimertinib alone is a palliative treatment with limited durability, which is not appropriate as first-line therapy for a patient who is interested in and eligible for definitive treatment. While the outcomes of the control arm of chemoradiotherapy without osimertinib in the LAURA trial were cer...