Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What CTV expansions do you use for NSCLC with conventional chemoradiation and do you do different expansions based on specific histologies?
We do 5 mm for all chemoRT cases and do not alter based on histology.
Is there an age that is too young for prostate irradiation?
Great question, and quite relevant, given that over 10% of newly diagnosed prostate cancers occur in men 55 years of age or younger. Although I consider a patient's "biological" age (lifestyle, performance status, etc) more than his chronological when deciding the UPPER age limit for radiation, it i...
What are your preferred strategies to manage mild to moderate rectal ulceration causing tenesmus and discomfort after chemoradiation for rectal adenocarcinoma?
Radiation-induced proctitis or tenesmus -- important to determine if the cause is external or internal to anal verge. Also important to rule out rectal fissures as this typically requires a different approach (Analpram cream and high fiber diet, +/- GI evaluation). If the cause is internal to anal v...
As PARTIQoL was a negative study, what is the current role for proton therapy in the management of prostate cancer patients?
Thank you for the comprehensive answer Dr. @Dr. First Last! It is interesting you talk about integral dose - that almost rarely comes up from the patient in my experience. They have read and have been told that it IS less toxic (not that it may be). They are told that protons are better and the auth...
How would you treat a oligometastatic para-aortic recurrence 1 year after definitive chemo-radiation for anal cancer?
We have successfully treated several patients with either synchronous or metachronous paraaortic nodal mets from anal SCCA with definitive dose chemoradiation. If not in a previously irradiated field- we give 50-58Gy in 25-29 fractions with concurrent cis and 5FU depending on the size of the node an...
What would you recommend for a patient with a new or locally recurrent anal cancer s/p chemoRT for anal cancer 15 years ago?
I would never irradiate a local recurrence of anal cancer for several reasons. The anal canal is a sensitive structure and the consequence of radiation injury is severe (ulceration, pain, bleeding). We could only give 39Gy in 26# BID or maybe 45Gy in 30#BID with two agent chemo. The cumulative dose ...
How do you manage palliative pelvic radiotherapy in a patient receiving Avastin?
Great question. Using Avastin with concurrent pelvic radiotherapy? The matter of serious adverse events led to an FDA ruling against its use concurrently with radiotherapy in 2007. The issues of thromboembolic events, bleeding, and fistula formation are a real thing with this drug and radiotherapy ...
How would you manage incidentally-found prostate cancer on TURP?
The patient's risk group along with genomic classification with Decipher would inform the treatment recommendation regardless of the source of the tissue. The pathologist should be able to estimate how much of the tissue had cancer and provide the Gleason Group. The location and volume of tissue are...
Would you recommend definitive XRT for prostate cancer in patients with prior Holmium Laser Enucleation of the Prostate (HoLEP)?
There are multiple options for outlet procedures in patients who present with baseline obstructive symptoms but prefer to avoid a radical prostatectomy. HoLEP is an effective procedure preferred by some urologists due to low re-treatment rates. HoLEP can often be quite aggressive leading to marked r...
How would you approach a patient with early-stage orbital MALT lymphoma with high proliferative index?
Local control for indolent lymphoma with 2 x 2 Gy is very good based on this series. Fasola et al., PMID 23726002. I am in favor of attempting 2 x 2 Gy and closely monitoring (together with an ophthalmologist) for possible recurrence, which can then be treated with full-dose RT (24-30Gy). This appro...