Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When would you consider testicular RT prior to TBI for BMT?
In children with ALL treated with systemic chemotherapy alone (no transplant), the risk of testicular recurrence is ~15-20% (Br J Haematol 2003;123:396, Br J Haematol 1998;102:656). In adults with AML treated with standard chemotherapy, with or without transplant using a chemotherapy alone condition...
How do you use Boswellia for radiation necrosis?
I reached out to my colleague, naturopath Lise Alschuler, Associate Director of the University of Arizona Fellowship Program in Integrative Medicine program, for her thoughts on this question. Here is her answer:This study by Upadhyay et al. is a well-designed study which builds upon earlier studies...
Do you routinely recommend consolidative radiation to bulky site(s) in the setting of advanced stage DLBCL?
How radiation therapy (RT) should be incorporated into the management of patients with advanced DLBCL continues to be investigated. In the setting of widespread, non-bulky disease, when a complete response is achieved with systemic therapy, I don't recommend consolidation RT. Though controversial, I...
In what situations do you order an Oncotype DX DCIS score for a patient with DCIS?
This is an excellent question. I suspect there will be many takes on this question since there is considerable controversy about omitting RT for DCIS in general. Here's what I think we know.Let's review the clinical data from the Oncotype Dx DCIS Score.1) Solin L et al JNCI 2013: A subset of the pat...
Should SBRT for bone metastasis be delivered daily, or every other day?
Canadian/Australian study gave 24 Gy in 2 fractions on consecutive days and no excessive toxicity was noted.I schedule them daily, but if there is a patient convenience issue, QOD is reasonable.It is very interesting, however - there is conflicting data on the efficacy of QD vs QOD for SBRT for lung...
How do you explain the risks and benefits of palliative radiation therapy to patients with fungating breast masses?
The value of palliative RT in these patients is to dry up oozing and bleeding and RT is very effective in achieving that goal. I have had success in these patients almost all the time and my usual dose is 30-39 Gy in 10-13 fractions.This study gives a prospective dataset for fractionation and pallia...
What is your approach to consolidation for localized small cell bladder cancer after neoadjuvant cisplatin and etoposide?
There is limited data with regard to the best management of these patients. Most data is retrospective and has an inherent bias. That being said, there seems to be a benefit for surgical resection after NAC (Patel et al., 24036236), with RT a consideration if surgery is not an option. In a small ser...
Do you ever treat cervical nodes above the standard supraclavicular field for breast cancer patients?
In the setting of biopsy-proven supraclavicular or cervical nodal disease, I do extend my fields cranially to include these nodes. I typically include the entire neck level based on head and neck contouring atlases and extend the cranial border at least 1 cm superior to the highest node. If nodes ar...
What factors do you take into account when deciding the length of adjuvant temozolamide in GBM?
The field is evolving from 12 cycles to 6 for IDH-wildtype GBM in recent years, on the basis of some retrospective studies and notably the prospective Spanish study GEINO 14-01 - there does not seem to be much OS benefit, and there are also toxicity concerns (myelosuppression, hypermutation). Extens...
What treatment sequence do you follow for patients with rectal cancer who are candidates for both PROSPECT and TNT/Watch and wait?
Thanks for this question. I am not sure whether this is up to us. This is up to our patients to choose which modality they would like to omit (radiation vs surgery). I would point out that a good quality MRI rectum should be performed to r/o any T4/N2 disease or potential requirement for APR. Otherw...