Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel patients receiving head and neck radiation regarding its impact on both existing and future dental work?
We send any patient who is having any portion of the maxilla or mandible to their primary dentist for an evaluation. If there is anything other than a simple restoration, we refer patient to a set of oral surgeons we work with for evaluation. They ensure any pre XRT dental root work is completed and...
Do you recommend prophylactic hyperbaric oxygen for patients who require tooth extraction after head and neck radiation?
The benefit of prophylactic HBO before extraction in HNC was determined in a single randomized study from 1985 (Marx RE et al), where pts received 2D RT, likely delivering the full tumor dose to the posterior mandible. However, using IMRT sparing the non-involved mandible (and producing a dose gradi...
Is there a threshold dose to the mandible above which you consider prophylactic HBO prior to dental extractions that are required after RT?
We do not consider HBO before extraction from parts of the mandible that had received high doses. If ORN happens, we would refer the patients to surgical debridement of the affected area if it does not heal spontaneously. Our experience is that strict prophylactic dental care, as well as IMRT aiming...
Is there a threshold absolute neutrophil count for which you would consider holding radiation?
I don't have a threshold dose for holding radiation. This decision is based on the etiology of the leukopenia. If the patient is receiving concurrent chemoradiotherapy it is usually the chemotherapy causing the issue and I rarely hold radiation even with ANC < 1000. If one were to hold both the chem...
Would you offer any adjuvant therapy for a young patient with anal cancer s/p definitive chemoradiation and R0 resection with significant residual disease?
We do not have complete details regarding the clinical history of this case. For instance, information about the patient’s initial response to chemoradiation—whether residual disease was identified early or if this represents a local recurrence after an initial favorable response—would be important ...
What is the optimal schedule for fractionated SRS treatment of CNS tumors?
I don't think there is one ideal dose/fraction schedule. Doses should be individualized for your institution, including factors such as immobilization, set up, and margins. There are published data on ranges of SRT.For larger tumors, typically defined as 2 cm to up to 3-4 cm I would favor 24-27 Gy i...
How do you reconcile discrepancies in clinical prostate cancer staging with AJCC and NCCN?
Fundamentally, I use NCCN risk categories to help steer conversations about staging and treatment options for very low vs low vs fav int vs unfav int vs high risk diseases. Therefore, I use NCCN staging in my clinical practice and notes and incorporate mpMRI into staging. I find it comforting that N...
What are your institution's standard liquid intake instructions for prostate cancer patients going through definitive external beam radiation?
Bladder filling is an endless source of stress for patients (and radiation therapists). It's hard for people to time bladder filling under ideal conditions, and even more challenging when the urethra and bladder are irritated from treatment. As the question alludes to, baseline hydration status infl...
Is 5fx APBI and no endocrine therapy a new standard of care for women over 70 years old with low-risk breast cancer given the interim analysis of the EUROPA trial?
How do you ask a woman to be the last woman to suffer for an unlikely, non-lethal recurrence? For women with low-risk breast cancer, endocrine therapy does not improve survival and is less effective at decreasing recurrences—we saw this in NSABP B-21. Yet it causes years of suffering: arthralgia, ho...
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 ...