Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In patients with breast cancer, do you use bolus when boosting a chest wall scar or flap with electrons?
In terms of evidence basis for use/non-use of bolus generally in the setting of post-mastectomy chestwall radiotherapy (not limited to electron boost, noting that the use of post-mastectomy boost at all is a topic worthy of debate), here's what I found when I explored the same question a few years a...
In patients receiving PMRT do you perform a boost if they have had reconstruction (tissue expanders,…)?
Ideally I think we should make treatment recommendations prioritizing the clinical features over the reconstructive approach. The benefit of the scar boost after mastectomy is unclear, and the target for the boost is also unclear, so I tend to reserve the boost for patients with multiple high risk f...
Can you give Pluvicto with concurrent palliative EBRT?
Short answer: Yes, you can, and I do not modify my dose. I have no issues with this and have done it multiple times for patients who need more immediate symptom relief (pain, bleeding, etc.).Why? Because Pluvicto is a medium energy isotope with a relatively short path length of around 2 mm. Even nea...
Would you radiate the thoracic duct for bilateral chylothorax in a hematologic malignancy with no discrete adenopathy?
We have done for adenopathy, which relieves obstruction and thus helps with drainage, but we don’t know how it would help in this situation.
Under what circumstances would brachytherapy be preferred over electron therapy for treating skin cancers?
For small (<2 cm) nonmelanoma skin cancers, I would say that brachytherapy is preferred for these reasons: Better cosmesis - 90-95% report excellent, which is better than electron series, particularly at the edge. Better for curved surfaces like the nose b/c applicator is flush on the skin with no ...
How do you manage chest wall pain due to SBRT?
Chest wall pain is not an insignificant consequence of thoracic radiotherapy, especially after SBRT. Most of the data describing chest wall pain comes from the SBRT era. Older literature (breast and lung treatment) tends to focus mostly on rib fracture with chest wall pain but rarely differentiates ...
Is it appropriate/safe to utilize bolus with ultra-hypofractionated breast radiation?
There are no data I know of on using bolus with the FAST-Forward regimen. I would be very reluctant to do so because of the lack of time for healing of the skin between fractions and concern about long-term hyperpigmentation and telangiectasias if the patient had breast-conserving therapy. However, ...
Would 45 Gy to the pelvis be sufficient for a locally advanced rectal cancer that has a complete metabolic response to TNT?
If you define the standard of care as what the vast majority of people do, the standard of care is to give 50.4 Gy in 28#, especially if nonoperative management is the goal. If surgery is part of the plan, we found that preoperative chemoradiation to 45 Gy followed by mesorectal excision resulted in...
Do you use specific scalp dosimetry constraints to prevent chronic alopecia when treating partial brain volumes with VMAT?
I do try to be mindful of scalp dose for partial brain VMAT, mainly to reduce the risk of alopecia. If feasible, I generally try to keep the scalp/skin max dose around 39 Gy to D0.03 cc or lower. That said, I would prioritize target coverage and overall plan quality if there is a tradeoff. In my pra...
Would you ever consider treating a patient with locally advanced NSCLC with SBRT to the primary tumor plus conventional mediastinal chemoradiation?
I would await the results of LU008 before doing this off-trial. The Phase 2 results from Heinzerling et al., PMID 39615497, that supported the development of LU008 statistically failed to meet its primary endpoint of >60% 1 year PFS (although it was likely just underpowered at 61 patients), but more...