Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you wait until a ureteral stent is placed to plan a locally advanced cervical cancer with hydronephrosis?
The simple answer is YES. We typically wait for ureteral stent placement before we start the radiation treatment planning process because of many potential benefits to the patient such as improving the patient's renal function status so she would better tolerate the full dose of cisplatin chemothera...
How do you manage a FIGO stage IB dedifferentiated endometrial carcinoma that is MMR deficient and p53 wt?
Aggressive disease. Favor chemo plus IO (MMR-d) (Van Gorp et al., PMID 39284383) followed by EBRT.
How do you manage dry eye syndrome due to lacrimal or meiobian gland dysfunction after external beam radiotherapy?
I have also found autologous serum (AS) or platelet-rich plasma (PRP) eye drops/tears to be extremely useful (provided by an ophthalmologist). Dry eye can also be exacerbated by graft vs. host disease, which I have anecdotally seen worsened within radiation fields and is characterized by a lasting m...
Do you have different hotspot and heterogeneity goals for SBRT of ground glass lesions vs more solid adenocarcinoma NSCLC lesions?
I would base my hot-spot goals more on lesion location and geometry than on appearance or other clinical factors.For a purely peripheral lesion, the planning focus is on conformality, and with an FFF beam allowing a high central hot spot by asking the planning algorithm to focus only on rapid fall-o...
Which patients with rectal cancer who have not received neoadjuvant treatment do you offer adjuvant radiation to?
In order to answer this question, we may need to step back and first review the indications for radiation treatment in the neoadjuvant setting.Neoadjuvant concurrent chemoradiation or short course radiation treatment is considered to be part of the standard treatment (recommended by guidelines) for ...
Do you administer prophylactic antibiotics for GU procedures?
The common GU procedures performed in radiation oncology are transperineal brachytherapy and transperineal retroprostatic hydrogel insertion. Rarely transrectal biopsy or transrectal intraprostatic injections may be performed by radiation oncologists. I don't believe any randomized studies looking a...
Is there a PSA value below which you would not offer salvage radiation post-prostatectomy?
I am commonly asked the inverse question: if I use a "PSA cutoff" whereby a rise beyond this value will strongly favor treatment with post-op radiation. I think it is difficult to have a set value that applies for all patients, as the decision to treat should be individualized to patient and disease...
What is the best treatment for a medically inoperable endometrial adenocarcinoma of the uterus FIGO 1, grade 1, type 1?
I would get a pelvic MRI to assess tumor size and myometrial involvement. If small volume (2 cm or smaller) with superficial invasion then use brachy alone, otherwise EBRT plus brachy. The type of brachy is based on uterine width: If the width is less than 5 cm: single tandem and cylinder. Otherwise...
Under what circumstances would you treat prostate cancer without a biopsy?
I largely agree with Dr. @Dr. First Last's comments as well as a prior post on this site in which anecdotes are cited of situations which falsely appeared suggestive of prostate cancer. As contemporary guidelines recommend treatment only in patients with localized prostate cancer with > 5-10 year li...
How would you adjust your CTV for a locally advanced rectal cancer case with invasion of the prostate?
I’m not aware of any “high level” guidance on this specific question. Most cases I see have limited invasion of the peripheral zone of the prostate and/or seminal vesicles. With the assistance of a registered MRI, I contour the gross primary tumor and add at least a 1 cm margin into the prostate. I ...