Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach an isolated Axumin PET-positive focus in the prostate bed in the setting of rising PSA after prostatectomy and salvage radiation?
In general, I do not offer reirradiation to the prostate bed following salvage radiation therapy, as the risk of causing significant late toxicity affecting the rectum, bladder and tissues of the pelvic floor is high if one were to try to deliver a dose that had a reasonable chance of achieving long...
In what situations would you treat with adjuvant radiation for resected gallbladder cancer?
Most retrospective studies have suggested adjuvant chemoradiation may be associated with better survival after resection compared with observation. Frequently identified risk factors for recurrence include advanced T or N stage and positive margins. What isn't known is what specific adjuvant therapy...
Would you offer adjuvant radiation for a patient who is incidentally found to have a pT2b NX adenocarcinoma of the gallbladder after a simple cholecystectomy?
Gallbladder cancer is often found incidentally, so this is a common scenario, but typically happens in around 1% or less of laparoscopic cholecystectomies. The best outcomes are achieved when patients are able to undergo re-exploration and resection, both because patients have a high risk of having ...
In a patient with history of early stage oral cavity cancer and a new ipsilateral neck failure, would you treat the initial site of disease?
At MDA we have for many years followed a guideline for the unirradiated patient with a metachronous neck recurrence from the oral cavity. I say guideline as we have not had ridgid adherence. Our guideline has been 1 year between the initial disease and the recurrence. If less than a year, we treat a...
What is your thought process for dose prescriptions when treating abdominal/pelvic lymph node oligometastasis with SBRT?
I don't love SBRT for nodal mets aside from unique situations. Although I agree they may represent a less aggressive phenotype than hematologic parenchymal mets they are also connected to their neighbors in a way a bone met isn't. SBRT is a very focal therapy when done well and so neighboring LNs do...
What is the maximum time you would allow between simulation/treatment planning MRI and delivered treatment for stereotactic radiosurgery for brain metastases?
All efforts should be taken to have the patient treated as early as possible after simulation. If a delay is inevitable, up to 7 days is acceptable in most situations. However, for patients with melanoma, due to risk of hemorrhage and potential aggressive progression, the delay should be shorter. Pa...
Would you ever omit adjuvant radiation for a patient with rectal cancer originally staged cT1N0, but found to be pT1N1 after surgery?
Certainly a topic that comes up not uncommonly in tumor boards. The gold standard comparing pre to post operative chemoradiation remains the German colorectal trial, and showed increase in acute diarrhea from 12% to 18% and long term GI sx from 9% to 15%, strictures from 4% to 12%. Although there is...
In which patients do you omit a boost following whole breast irradiation?
In a woman over 60 with a T1 or T2, low to intermediate grade tumor resected with clean margins (preferably greater than or equal to 2 mm), I think it is very reasonable to omit a boost. I tend to take these on a case by case basis. If I can deliver a boost with a small field (for example 8 cm or le...
Why is it recommended that patients not apply moisturizer in the radiation field immediately prior to daily treatment?
The received wisdom of Radiation Oncology that patients should not apply topical agents before radiation treatment was promulgated out of concern that said topical agents would act as "bolus" of sorts, and increase the radiation dose to the skin in a way that would enhance radiation dermatitis. For ...
How do you counsel patients on sun exposure during radiation?
I tell them to avoid sun exposure as much as possible if in the area(s) that need to be radiated. Beyond standard recommendations about the sun and the risks that should be part of their normal MD (GP) or dermatologist conversations, we can cause skin reactions with RT and it is important to have as...