Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you wait to treat small asymptomatic brain metastases until they reach a certain size?
I typically treat all lesions on MRI that are found to be concerning for brain metastases. This is after a discussion with our neuroradiologist colleagues. If there is uncertainty that a small lesion may not be a brain metastasis, then I will elect to follow with a surveillance MRI and treat in the ...
How do you determine the timeline for healing after craniotomy prior to starting chemotherapy and radiation?
I typically wait at least 10-14 days post-op, always after neurosurgery has re-evaluated the craniotomy site for appropriate healing and has already removed staples or sutures.
Is there additional concern for late cardiac toxicity when using ultrahypofractionated breast radiation protocols, given that the BED to the heart is higher?
The BED to the heart isn't actually higher in this setting.Dr. @Dr. First Last explained this below, but I'll just explain it another way. Imagine that you place the block edge so that it is touching the heart (i.e., the heart is completely covered by the MLCs, and there is no margin between the MLC...
How would you empirically manage a large sellar/suprasellar mass with encasement of the right cavernous and terminal internal carotid arteries?
Knowing the histology of the mass would really help in creating more accurate treatment recommendations. A biopsy of a sellar mass is usually accomplished by an endonasal-endoscopic trans-sphenoidal approach utilizing the expertise of an ENT surgeon and a skull-base neurosurgeon. However, in this ca...
Would you consider neoadjuvant immunotherapy prior to radiation for a locally advanced skin squamous cell carcinoma?
While the definitive trials are yet outstanding and enrollment in NRG HN0014 (NCT06568172) should be encouraged where it is open, the present indications for using cemiplimab should follow its principal indication, unresectable cutaneous squamous cell cancer, a minority of cases at 5%. Practically s...
What is the optimal duration of ADT in high-risk prostate cancer treated with RT+ADT?
Nabib et al. presented "Final Results" of the 18 vs. 36 month ADT trial for high-risk M0 prostate cancer in Chicago during ASCO 2017. This trial has the potential to be practice changing, since most men receive 2+ years of ADT during RT-ADT for high-risk disease. 630 patients were randomized and OS ...
Is it acceptable to treat patients with limited, asymptomatic brain metastases and EGFR-mutant NSCLC with upfront TKI?
Though some clinicians have been exploring the idea of targeted therapy for EGFR mutant brain metastases, this has been done in the absence of strong evidence. Reasons for pushing this idea are that sometimes the lesions seem to respond, and this has been seen in some single arm studies and anecdota...
What are best practices for radiation oncology patient and staff precautions with the COVID-19 pandemic?
COVID Update 1/30/21 Wow, it's been almost a year. Here are some updates from our practices at University of Maryland. We have successfully treated both PUIs and COVID+ patients at all of our practices. We have yet to have a patient to staff (or staff to patient) transmission. We do not break patien...
When treating the whole brain with hippocampal avoidance, do you ever deliver SIB to gross disease?
There have been several papers and an ongoing trial evaluating the safety and efficacy of including SIB to macrometastatic disease with HA-WBRT. A recently published trial from the UT-Southwestern team was a single-arm phase II trial, which treated 50 brain metastasis patients with HA-WBRT to 20 Gy ...
Do you recommend chemoradiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?
Tough question, with lots of evolution in this area in the past few years. The data would suggest that for borderline resectable pancreatic cancer, there is a benefit in terms of OS from preoperative treatment. For unresectable disease, the small chance of conversion into resectability is worth the ...