Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach volumes and dosing when using SBRT for a biopsy-proven NSCLC lung nodule with a central solid component and surrounding ground glass opacity (GGO) appearance?
@Dr. First Last, first of all, congratulations on finding our rather obscure article. It's heartening to know that it's impact has reached such high levels that a specific literature search on the topic by my esteemed colleague @Dr. First Last fails to find the article. I shall have to resort to soc...
Would you offer SRS to a hippocampal metastasis in a patient with ES-SCLC treated with prior WBRT?
I agree with Dr. @Dr. First Last. The brain metastasis is a greater risk to the patient than SRS would be. Whether the prior WBRT used hippocampal sparing or not would not change my recommendation.I am not well-versed in neurocognitive anatomy. But it is feasible to injure (or remove) 1 hippocampus ...
When do you offer adjuvant chemotherapy after wide-local excision for soft tissue extremity sarcomas?
High risk extremity and superficial trunk STS, AJCC stage 3. Data is more convincing in Sarculator, which projected a risk of recurrence higher than 40%. If resection has already happened, adjuvant XRT has to follow first before adjuvant chemotherapy.
How do you optimally set a patient up for breast radiation therapy if you don't have access to a breast board or wing board?
"Optimally" is a continuum and hard to define. Without a breast board or wing board, a vac-lok bag might be your best bet. You can often move much of the "beans in the bag" superiorly in the bag, so that you can create something to support the patient's ipsilateral arm(s). Plus, moving the beans sup...
How will you treat an uterine embryonal rhabdomyosarcoma with regional node involvement resected to involved parametrial margins?
It's hard for me to say how I would treat the patient as described without a bit more information and review of the case. So, I will make a few general comments. One major question is, "What is the age of the patient?". And I assume from the question that the parametrial margins were involved. Two t...
What is the risk of radiation therapy to an abdominal aortic aneurysm infiltrated by lymphoma?
I have no personal experience treating an AAA infiltrated with lymphoma. I believe, however, it is appropriate to draw an analogy with treating stomach or bowel involvement with lymphoma. In this situation, chemotherapy may well result in perforation due to rapid tumor shrinkage, whereas fractionate...
What is your preferred dose to gross lymph nodes when treating non-metastatic high-risk prostate cancer?
I treat the grossly involved node as high as I can, while respecting OAR constraints, up to the dose for the prostate. I tend to favor zero or minimal PTV margin (depending on the proximity of OARs--usually bowel) and allow the penumbra to serve as a functional "PTV."
How would you manage a patient diagnosed with squamous carcinoma involving the entire length of the vagina and extends into the vulva (introitus), who has severe vaginal stenosis?
If this is a vaginal lesion involving the vulva, it should be classified as vulva cancer and treated like so. Typically with ext beam boost to 66 to 70 Gy.
What bladder constraints do you use for prostate cancer patients who have a completely empty bladder?
There are some situations where there really is no urine in the bladder for which empty bladder constraints are needed. However, the vast majority of the time empty bladder is due to incontinence after prostatectomy. This is an especially important situation since a portion of the bladder is in the ...
How would you palliate a metastatic lesion abutting a joint with an associated effusion?
I don't know that there is data for this - not that I could find. Bone metastases themselves cause pain due to multiple factors - mass effect, inflammation, and microenvironment changes. I'd guess the effusion is potentially due to the existence of the metastases (an inflammatory reaction), rather t...