Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of radiation therapy in recurrent Rosai-Dorfman disease after surgical resection, which manifests as many cutaneous lesions on the arms and buttocks?
I agree with Dr. @Dr. First Last. When I was in training, we reviewed the cases at MD Anderson. Radiation was only used for 9 patients (infrequently), and local control was achieved in 4 patients. So very small numbers, with uncertain benefits. Median RT dose 36 Gy. In the setting of multifocal dise...
How do you assess whether a patient will be a good DIBH candidate for lung or abdomen treatments?
Assessments are made at the time of simulation. Every patient has a motion assessment performed to determine the degree of motion management required. Typically, if a patient has >1 cm of motion, we will determine if DIBH is appropriate. Patients undergo a coaching protocol using audio/visual feedb...
Is active rheumatoid arthritis (RA) a contraindication to hypofractionated breast irradiation?
Active RA with some sort of skin manifestation may make me consider delaying/deferring RT, but it would not change what fractionation I use.Here is recent data that shows no difference in toxicity across various fractionation schemes in patients with CVD.
Do you recommend Hyaluronic Acid Therapy for vaginal dryness in female patients post pelvic RT?
I do not. Not saying you shouldn’t though. I recommend coconut oil which can be used with a vaginal dilator, for intercourse or purely for hydration. If ineffective, I will refer back to gynecology. There may be a role for topical estrogen depending on the cancer histology.
What is the optimal adjuvant vaginal brachytherapy schedule when a patient is getting concurrent chemotherapy?
I offer 7 Gy x 3 weekly, but prefer 6 Gy x 5 to surface regardless of when chemotherapy is given. We have some currently unpublished, but upcoming institutional research submitted to ABS 2025 that showed increased risks of vaginal stenosis with 21 Gy in 3 fx to depth compared to a more gentle fracti...
How would you approach treatment for a primary carcinosarcoma of the cervix with pelvic and para-aortic nodal involvement?
There is limited information on this situation. A series from Washington University (Gynecol Oncol 2005; 99: 348) demonstrates that curative intent treatment can be rewarded with long term survivals if disease is confined to the pelvis. Curative treatment could include chemo-RT, radical surgery, or ...
How would you approach a young patient with a locally advanced endometrial cancer with cervical involvement and a solitary bone metastasis?
I would need to know what is meant by locally advanced endometrial cancer. Locally advanced cervical cancer usually means not operable (except IB2) so is this a T3N?M1 pt with a bone met? That is IVb. I agree with bone biopsy but endo does go to bone so I would not be surprised if this was positive....
Would you offer adjuvant RT to a FIGO IV endometrial CA with pulm mets s/p hysterectomy with residual disease, then cCR to both sites after chemotherapy?
For stage IVB with extra pelvic mets to lung or liver, I have not offered adjuvant RT as the high risk of other mets would negate any benefit of adjuvant RT. If they develop isolated local relapse, then would consider for salvage.
How do you address extended break from EBRT during cervical cancer treatment?
EMBRACE data suggest HRCTV dose needs to be increased by 5 Gy for each week delay beyond 50 days to counter the downside of delay. We try to do that using hybrid applicator but total dose is still limited by OAR dose and we try to push as much as we can. (HRCTV to 90-95 Gy)
What would you recommend in the adjuvant settings for an elderly patient status post hysterectomy without nodal staging and was found with FIGO 1A, G3 endometrial cancer, with no LVSI and no myometrial involvement, without nodal staging?
Imaging for staging. Brachytherapy alone as adjuvant treatment.