Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Do you recommend self-breast exams to your patients with history of breast cancer in addition to imaging surveillance?
This is a somewhat controversial question. I cannot find any data on the risks or benefits of counseling on self-exams in breast cancer survivors. I will simply say this. Among survivors, there are differences between patients that I think the physician must understand and meet the patients where th...
How do you treat a high grade prostate cancer with bulky direct bladder invasion?
Interesting to see a treatment paradigm presented where an insurer would fathom A) protons and B) fluciclovine for staging, and C) second generation anti-androgen on top of LHRha to treat a locally advanced, non metastatic prostate cancer. I agree that there is the possibility that some of these thi...
How do you approach cranial radiotherapy in a patient with a cochlear implant?
There are a number of studies that show that cochlear implants can tolerate high doses of radiation. For doses that we typically use, there does not appear to be a major decline in performance when exposed to radiation, either with conventionally fractionated doses or SRS doses. https://www.ncbi.nlm...