Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?
I am going to "eat a bit of crow" here and admit to having been schooled a bit by the esteemed Dr. @Dr. First Last. I admit to having immediately jumped to the post-rad hyst situation rather than post-exenteration, and I agree that the radicality of the operation could factor into the decision about...
Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?
Would treat same with EBRT to 45 Gy in 25 fractions. (Pelvis) With concurrent chemo and brachy.
Can trastuzumab deruxtecan be continued during radiation?
Data is limited, with the suggestion of higher necrosis with SRS. For other sites for palliation, I would not say it’s contraindicated, but caution needs to be exercised especially for the risk of increased lung and GI toxicity (because of independent toxicity from the drug and the potential for sen...
Given the negative results of GOG-0238 but the positive results of the RUBY trial, how do you manage isolated vaginal cuff recurrence of endometrial cancer?
I would favor definitive RT alone and reserve chemo plus IO for systemic or nodal relapse.
Do the number of lymph nodes removed in a non-Stage IA/FIGO 1 endometrial cancer case, affect your decision for WPRT v. vaginal brachytherapy alone?
Yes, in some cases it does—for two reasons. If a patient has had an extensive negative node dissection, the risk of extravaginal pelvic failure is undoubtedly less and the risk of RT complications may also be greater than if the patient had hysterectomy only. These factors define the “therapeutic ga...
What is the biggest mistake people make when using IMRT to treat cervical cancer?
I can't say for sure what the biggest mistake people make is, but some common issues I see when reviewing others' contours are: Using insufficient margins around the vessels when contouring the nodal volume (CTV) Using insufficient planning margins around the vaginal cuff (postop) or cervical mass/u...
What is the role of parametrial and pelvic side wall boosts in the setting of volumetric brachytherapy for locally advanced cervical cancer treated with either 3DCRT or IMRT?
The rationale behind the parametrial/side wall boost could be one or both of below 1. Treating the parametrium 2. Boosting involved pelvic nodes If it's done for an additional boost dose to the involved nodes, then the nodes should be contoured and dosimetry should be done to ensure coverage of invo...
How would you approach the management of a patient with locally advanced cervical cancer as well as synchronous endometrial adenocarcinoma?
The short answer is--treat both malignancies with a therapeutic plan that addresses them both. While the question fails to provide the details necessary to navigate the particular situation, some guiding principles can be asserted. 1. Intensity of therapy should be proportionate to the more dangerou...
How do you sequence vaginal cuff brachytherapy with EBRT for post-op endometrial or cervical cases that require both modalities?
We do sequential without any break after EBRT
In a patient with a vaginal cuff recurrence from endometrial cancer not amenable to interstitial brachytherapy, how would you boost after 45Gy?
If not amenable to brachy which is unusual in our practice, we would use IMRT boost to 66 to 70 Gy.