Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider BID treatment for a patient with a pelvic SCC (e.g. cervix or anal) if a significant amount of treatment days have been missed?
We frequently bid patients for up to 3 fractions to make up for holidays or other breaks in treatment--we have not found this to be a problem, particularly if the bid treatments are space out a bit. We generally require a 6 hour interfraction minimum interval. The maximum number of days we are willi...
How do you counsel a cervical cancer patient s/p definitive chemoRT who is not sexually active and refuses to use vaginal dilators to improve compliance?
There isn't much you can do except talk with them about the reasons for non-compliance (has it been painful, embarrassing, discuss rationale and encourage them. Are they unsure how to use it?- having them insert it during their clinic exam may help. If the dilator is causing pain, lubricants or vagi...
How do you manage bladder fullness during cervical T&O brachytherapy to minimize OAR dose?
We usually treat with empty bladder as it is reproducible. But if at first fraction any loop of small bowel close by then for remaining fractions we simulate and treat with full bladder to decrease dose to small bowel (usually 120-180 cc fluid).
What dose is needed for salvage RT for recurrent endometrial cancer in untreated PA region (who has received pelvic RT) after good PET response to systemic therapy?
I usually treat 45 Gy in 25 fraction to chain, and 55 in 25 to residual normalized node.
How would you manage a patient with 1B2 adenocarcinoma of the endocervix s/p TAH/BSO who was found to have bilateral metastasis to Fallopian tube, a 1 cm pelvic side wall metastasis, and no LN metastasis?
We treat these patients like high-risk post op cervical cancer with concurrent chemo RT with weekly cisplatinum. We also discuss the option of adding adjuvant chemo after chemo RT with taxol and carboplatinum.
What are your image guidance instructions for post-op endometrial cancer EBRT?
We treat all these patients with IMRT now and they are simulated with full and empty bladder. We do not place any fiducials as they tend not to stay in place. Patients are always treated with full bladder and empty rectum (as much as possible). Daily CBCT is used for matching bladder and rectum an...
What dose and target volume do you use for neoadjuvant chemoRT in a patient with a locally advanced uterine/endometrial cancer involving parametria, cervix, and the uterine fundus (no side wall involvement) requiring downstage to be eligible for surgery?
Presuming that this is an endometrioid cancer - I would start with RT +/- chemo. There is potential for there to be sufficient shrinkage to facilitate brachytherapy boost. I do appreciate the link Dr. @Dr. First Last published, and would consider doing SBRT with a neoadjuvant dose how we would as pe...
How would you manage a patient with FIGO 2018 IA G3 endometrioid adenocarcinoma with substantial LVSI, and was N- with adequate nodal staging?
I continue to treat based on the 2018 group staging system, although I acknowledge the valuable prognostic insights gained from histology and molecular features incorporated into the 2023 system.When discussing treatment options with the patient, I avoid framing them as 'more aggressive' or 'less ag...
What is your strategy to deliver EBRT, brachytherapy, and a parametria/lymph node boost in less than 7-8 weeks for cervical cancer?
These are the things we do to accomplish this: 1) Up-front planning for the entire course. Schedule brachys before the start of external beam, particularly if you are dependent on an OR, gyn oncologist or anyone else who might require advance notice. The first brachy should be scheduled no later tha...
What are you posterior field borders for endometrial and cervical cancer 3DCRT plans?
The idea behind placing the posterior border 5 mm behind the sacrum on the lateral fields is to include the presacral fossa where the presacral nodes reside. I recommend covering the presacral nodes for all definitive cervix patients, both for prescral node coverage as well as to cover the parametri...