Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Under what circumstance do you offer a definitive approach to local treatment of a patient with oligomestastatic cervical cancer found on initial staging PET/CT?
FIGO stage IVB Cervical CancerCervical cancer spreads in an orderly fashion predominantly via the lymphatic system and subsequently hematogenous spread to the lung and elsewhere.The FIGO stage IVB cervical cancer includes those with distant nodal metastases (para-aortic or supraclavicular lymph node...
What are the risks of treating locally advanced pancreatic cancer with chemoradiation with duodenal stent in place due to malignant obstruction?
There is no increased risk from radiation treatment when a duodenal stent is in place.
What are your target volumes for treatment of a hemorrhagic brain metastasis with SRS?
If this is an unresected hemorrhagic brain metastasis, I would consider covering hemorrhage while taking into account my RT volume. There is data showing that hemorrhagic brain metastasis is associated with inferior local control/outcomes vs. non-hemorrhagic brain metastasis after SRS (PMID 29936319...
Would you treat endometrioid adenocarcinoma arising from an endometriosis lesion in a patient with prior hyst/BSO like an ovarian or endometrial primary?
For a patient with prior hyst/BSO and now an endometriosis-associated endometrioid adenocarcinoma, I would start by getting next-generation sequencing and MSI/MMR testing of the tissue specimen that was used to make the diagnosis. This would allow for additional information and the potential use of ...
Would you offer PMRT when the only indication is a focally positive margin?
If this is the only indication (T1-T2N0 and no other risk factors like LVSI, high-grade disease, triple negative, etc.), then would consider only if the patient was younger (<50 years old). It appears these patients have a much higher rate of recurrence than older patients and chest wall-only RT is ...
How do you approach small bowel constraints in the setting of reirradiation?
This is a very tough question to answer. I agree with Dr. @Dr. First Last's answer.The maximum dose for the small bowel during reirradiation can vary depending on various factors such as the previous dose received, the interval between radiation treatments, the purpose of reirradiation (palliative o...
What uterine risk factors do you consider when recommending VBT boost after EBRT?
Since most patients who need EBRT now have high risk disease with more than one adverse factor, we prefer EBRT 45 Gy in 25 followed by 5 Gy x 2 for almost all unless the patient declines brachytherapy.
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 ...