Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there select patients with rectal cancer where radiation field size reduction might be feasible?
Yes, however, how to select which patients could have a field size reduction is unknown. Such a field size reduction is probably even more acceptable in the era of total neoadjuvant therapy, however, this cannot be considered standard of care given the absence of trials evaluating such novel approac...
How would you manage an elderly female patient with a remote history of synchronous bilateral invasive ductal carcinoma with a new triple-negative recurrence in the left breast and axilla with extension to the contralateral breast?
Unfortunately, if no good systemic options are left including pembro/parp inhibitor then the outcome is most likely palliative. Will try a hypofractionation schedule for palliative/preoperative dose of RT.
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 ...
How would you manage a small posterior vaginal defect noted at the time of cervical brachytherapy?
If it is from a disease, I would continue brachy as planned and address the defect based on response and healing. If unrelated to disease, I would have it sutured and continue brachy as planned.
Would you offer hippocampal sparing whole brain radiation for patients with brain metastases due to ES-SCLC?
Until we have built-in auto-segmentation, I find the RTOG contouring atlas very helpful for manual contouring of the hippocampus. I tend to use the lateral ventricle as my main landmark, and look for the circle of gray matter located medial to it. Once I've drawn a hippocampus, I'll look at it in th...
Do you use either memantine or hippocampal sparing technique to preserve cognitive function when giving whole brain radiotherapy?
Dr. @Dr. First Last and I put together the response below:We use memantine and hippocampal sparing technique for all brain metastasis patients who are planning to receive WBRT. This is based off the recently published phase III trial NRG CC001 that found hippocampal avoidance WBRT plus memantine res...
Is long term ADT now the standard of care with salvage prostate bed RT?
The dreaded hormone question...After 40 years of embarking on extremely well designed randomized trials, we still are confused about the who, what, when of ADT. Will RTOG 9601 create a new care standard? As @Dr. First Last said, I think we will see increased utilization. I have been using bicalutami...
For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?
I usually favor RT alone as local control and the outcome is excellent unless they have adenocarcinoma, a suspicious pelvic node, or multiple high risk features (high grade with LVSI on bx).
What factors do you consider when selecting dose/fractionation for whole brain radiotherapy?
I assume this question is for brain metastases patients who are not eligible for hippocampal avoidance WBRT (ineligible criteria including but not limited to - mets 5 mm within either hippocampus, germ cell/small cell/lymphoma, leptomeningeal disease, etc.) - my default WBRT dose fractionation is 30...
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...