Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a female in her 40s with stage III cervical cancer with hydronephrosis and Crohn's disease?
I would treat with definitive chemo RT minimizing bowel exposure as much as I can with IMRT (adaptive if possible so can treat with tighter margin and IGBT) and inform the patient about the risk of complications.
How does positive peritoneal washings factor into your treatment decisions regarding pelvic radiation and/or chemotherapy?
At this point, for patients who lack other adverse factors, we do not change management based on positive cytology for endometrioid histology.
How would you treat an isolated port recurrence of an early stage cervical patient s/p WLE?
In limited cases we have managed this with surgery and chemoRT as definitive treatment
Would you use different EBRT field edge for an HIV positive patient with FIGO IIIC1 (2018) cervical cancer with positive bilateral external iliac nodes?
In any situation I would not favor bony landmark and use anatomical vascular landmarks. This is a review article in Seminars in Radiation Oncology summarizing nodal RT for cervical ca written with North American and European collaboration.
Do you continue Megestrol in a patient with inoperable endometrial cancer during definitive radiation therapy?
I usually stop megace as definitive RT takes care of bleeding and disease . This also reduces risk of megace induced side effects
How would you approach an inoperable, elderly, frail patient with high risk endometrial cancer?
May be less toxic, unless patient is "inoperable" because of high anesthesia risks, making endometrial brachy risky.
How does the presence of microcystic elongated and fragmented (MELF) invasion impact post operative treatment of Stage IA FIGO grade 1 endometrial cancer?
MELF pattern may be associated with under-assessment of LVSI. In the setting of surgical assessment of nodes, we don’t change treatment recommendations just based on MELF pattern.
What is your treatment approach for an adenoma malignum of the cervix?
Data for this rare entity is mixed but for now, treat with the same philosophy as other histology with chemo RT.
Do you have cut off values for neutrophil and platelet counts when doing interstitial brachytherapy for cervical cancer?
Aim for ANC 1K and above and platelet 50K and above. Also look at the trend, if ANC is going up can do at a lower value as long as above 500.
In light of the SHAPE trial results, how would you manage a patient with an incidentally diagnosed FIGO IA1 cervical cancer after simple extrafascial hysterectomy/BSO?
Without question, I would recommend that this patient receive pelvic RT and probably cuff brachytherapy as well. The SHAPE trial (NCT01658930) enrolled "low risk" patients, but they allowed LVSI patients into the trial, even though this is a high risk feature for local recurrence. There were approxi...