Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What rectal spacer do you recommend for prostate cancer patients?
I’ve only ever worked with SpaceOARs. I’d be interested to hear from providers who have gotten to work with both. There are similarities between both. A similar amount of total volume is injected with either procedure. Both products begin natural resorption around 3 months after placement. SpaceOAR ...
When do you recommend induction chemotherapy prior to concurrent chemoradiotherapy for locally advanced NSCLC?
I rarely recommend induction chemotherapy prior to definitive concurrent chemoradiation. This is because two randomized studies, LAMP (PMID 16087941) and CALGB 39801 (PMID 17404369) showed no survival benefit and added toxicity with induction chemotherapy compared to concurrent chemoradiotherapy alo...
What radiation dose would you use to treat a symptomatic osseous lesion secondary to AL-amyloidosis?
Extrapolating from our tracheobronchial experience, we’ve used 20 Gy in 10 fractions to target the underlying plasma cells that produce amyloid production. We’ve also used this regimen for ocular and GU (ureteric and bladder) amyloidosis. If there are obstructive or symptomatic lesions, then surgica...
How long do you wait to start adjuvant radiation after prostatectomy?
Generally, I will wait until the patient has recovered urinary continence before beginning adjuvant RT. In most cases, that will occur by about 3 months, but I have had patients in which I have waited as long as 12 months before beginning adjuvant RT because continence was slow to recover. In cases ...
When using oral contrast for simulation, how much prior to simulation do you have patients drink the contrast?
I would also add that the downside of giving oral contrast is that some contrast can remain in the stomach and cause stomach distention. When you are giving neoadjuvant, adjuvant or palliative doses this is a not an issue. However if you're giving ablative doses such as we are now giving for pancrea...
How would you manage a patient with early-stage invasive ductal carcinoma with associated low-grade DCIS who was found to have ADH at the tumor margin on post-op pathology?
Presume it is focal and not diffuse involvement by AFH, I would get pre RT mammogram and if no residual calcification or abnormality, would proceed with RT.
How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?
The role of RT in MM is palliative in nature, and the focus should be on symptomatic improvement while minimizing marrow toxicity.Rad Oncs, as a whole, should not generally be using solid tumor palliative doses (such as 3 Gy x 10) routinely in MM as that ablates the marrow in that area without hope ...
How likely is late radiation induced lumbosacral plexopathy from treatment of anal cancer with chemo-RT 20 years ago and how would you manage it?
It's difficult to say "how likely" since we don't really have good long-term reporting for this specific late complication. I would say it's rare, but certainly possible. Late lumbosacral plexopathy has been reported as far out as 36 years from pelvic RT (Krkoska et al., PMID 36510189).In general, t...
What is your preferred approach in a patient unable to fill their bladder during prostate radiotherapy?
If a patient is willing to do a penile clamp or foley, then sure, go for it. Some patients want to 'do everything' and either is reasonable. Whether or not they need to is another question. Most Grade 3+ GU toxicity is either hemorrhage or stricture. Unfortunately, there isn't great data for any con...
Is 10 Gy x 5 an acceptable dose to use for lung SBRT in tumors with favorable location (eg. not central and not encroaching on the chest wall?)
The paper cited, which my colleague Kevin Stephans authored, used our large institutional data base with long term follow up to carry out a retrospective review of BED adjusted SBRT schedules and showed no difference in overall survival, but slightly improved local control, with higher BED schedules...