Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For vaginal cuff recurrence of an endometrial cancer, when do you utilize a multichannel cylinder versus single channel cylinder if a patient has <5 mm residual disease after EBRT?
If disease is confined to one wall, favor MC applicator as I treat vaginal wall thickness for side involved while surface on other side. MC allows that flexibility.Here is the link to our publicationGebhardt et al., PMID 29929925
Would you treat an inoperable <5 cm NSCLC tumor involving the hilum with SBRT?
There is legitimate concern with the development of late toxicities such as bronchial stenosis and hemopytsis after SBRT for centrally located tumors. The recently updated data from RTOG 0813 confirms that even with early stage, node negative, centrally located tumors, there is an approximately 5% r...
How do you treat Stage IIIC T4N3 NSCLC?
Probably need a bit more information since T4 is fairly heterogeneous, but it is absolutely treatable. If it involves both ipsilateral lobes, then SBRT to one isolated lesion and CRT for the rest is one approach. If T4 is involved in critical mediastinal organs, probably some induction therapy with ...
Do you use a liver dose constraint for right-sided breast cancer?
I don’t do it routinely as it is an infrequent significant issue clinically. In some cases, when tangent includes a significant bite of liver then try to adjust MLC following ALARA principle.
Have you encountered somnolence syndrome after whole brain radiotherapy?
Not specifically that I can recall. However, we should acknowledge that radiation oncologists might not be following our patients following whole brain RT with the optimal degree of diligence. Patients often have a limited life expectancy, are being followed and treated by other physicians. I suspec...
For post-operative radiation of resected high grade soft tissue sarcoma, how long of a delay do you tolerate before starting radiation?
The default/ideal answer is 4-6 weeks, but agreed that is often not feasible. In those circumstances, actively maximize wound healing efforts (plastic surgery, wound care service, lymphedema PT, etc) and start as soon as the surgeon feels it is safe to do so. But it does need to be safe, and ok by t...
How do you advise patients on cardiotoxicity when they are expected to receive a low mean heart dose and low cardiac substructure doses with their radiation plan?
I would say something along the lines of: "Radiation therapy is an effective tool for treating your cancer. However, whenever we give radiation therapy, there is always some incidental dose delivered to the adjacent normal tissues. We cannot make the dose zero to all of the normal tissues. Thus, we ...
How would you treat an unresectable epithelioid angiosarcoma invading the cavernous sinus, wrapping around the carotid artery?
Stage with PET and MRI. If any concern for intradural spread, complete spine imaging and consider LP to r/o LMD. Start with neoadjuvant taxane-based chemotherapy, potentially in a doublet (e.g., gem/tax). Then definitive CRT with concurrent taxol and conventional fractionation to 70 Gy, while respec...
How do you manage symptomatic fat necrosis following adjuvant breast radiotherapy?
If the diagnosis of fat necrosis is not in doubt (i.e., recurrence has been ruled out) and is not getting better: You can start with NSAIDS, warm compresses, a supportive bra, and massage therapy. Then, I'd consider steroids, though evidence is limited, Prednisone 20 mg for a week or so. Some peopl...
What do you do for patients who require radiation for breast cancer (either post-lumpectomy or post-mastectomy) but who have a pacemaker on the ipsilateral side?
A pacemaker is always a challenge when located in or nearby a radiation field. Typically, I would prefer to treat patients as I would normally treat them so as not to compromise care. However, that may require moving the pacemaker to the contralateral side. When treatment is ready to start, protoc...