Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?
This is a common clinical question that has been repeatedly explored in meta-analyses and clinical guidelines. Consistently, there's no evidence to support primary prophylaxis for seizures in patients with brain tumors including brain metastases. In summary, the data does not support the routine use...
For external-beam partial breast irradiation, if the CTV lies close to the skin surface, do you apply bolus?
We do sometimes use bolus if the skin surface is within 1 cm of surgical cavity and also make sure when planning there is flash created to account for inter fraction and intrafraction motion.
Do you wait until a ureteral stent is placed to plan a locally advanced cervical cancer with hydronephrosis?
The simple answer is YES. We typically wait for ureteral stent placement before we start the radiation treatment planning process because of many potential benefits to the patient such as improving the patient's renal function status so she would better tolerate the full dose of cisplatin chemothera...
Do you have different hotspot and heterogeneity goals for SBRT of ground glass lesions vs more solid adenocarcinoma NSCLC lesions?
I would base my hot-spot goals more on lesion location and geometry than on appearance or other clinical factors.For a purely peripheral lesion, the planning focus is on conformality, and with an FFF beam allowing a high central hot spot by asking the planning algorithm to focus only on rapid fall-o...
Which patients with rectal cancer who have not received neoadjuvant treatment do you offer adjuvant radiation to?
In order to answer this question, we may need to step back and first review the indications for radiation treatment in the neoadjuvant setting.Neoadjuvant concurrent chemoradiation or short course radiation treatment is considered to be part of the standard treatment (recommended by guidelines) for ...
Do you administer prophylactic antibiotics for GU procedures?
The common GU procedures performed in radiation oncology are transperineal brachytherapy and transperineal retroprostatic hydrogel insertion. Rarely transrectal biopsy or transrectal intraprostatic injections may be performed by radiation oncologists. I don't believe any randomized studies looking a...
Is there a PSA value below which you would not offer salvage radiation post-prostatectomy?
I am commonly asked the inverse question: if I use a "PSA cutoff" whereby a rise beyond this value will strongly favor treatment with post-op radiation. I think it is difficult to have a set value that applies for all patients, as the decision to treat should be individualized to patient and disease...
How would you adjust your CTV for a locally advanced rectal cancer case with invasion of the prostate?
I’m not aware of any “high level” guidance on this specific question. Most cases I see have limited invasion of the peripheral zone of the prostate and/or seminal vesicles. With the assistance of a registered MRI, I contour the gross primary tumor and add at least a 1 cm margin into the prostate. I ...
How would you treat a carcinoma in situ of the larynx with involvement of the false cord and arytenoid mucosal surface?
63 Gy/28 fractions larynx only
Is there a chest wall constraint you typically use for 60 Gy in 15 fraction NSCLC treatment?
We generally keep chest wall Dmax <110% and keep as much 105% out of the chest wall as possible, with a very low-priority goal of V4000 cGy <30 cc. I am definitely not strict about this in most cases, especially the volumetric goal.