Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does a negative PSMA PET change your management when completing salvage radiation for prostate cancer?
It's important to remember that if patients are being referred early for salvage RT, most of them will have negative PSMA PET/CTs (< 50% are positive if the PSA is < 0.5). So, in these cases, you are relying on the usual factors to decide on treatment fields, dosing, and the use of ADT, including ot...
What is your approach to prescribing gabapentin for oral mucositis prophylaxis during chemoradiation?
It can be a useful adjunct therapy, especially for patients getting radiation for oral cavity cancer. Randomized trials have been conflicting but some have shown benefit in a prophylactic setting. In my experience, patients tend to need less narcotic medication (usually able to get by with gabapenti...
What is your approach to treating inoperable mucosal melanoma of the head and neck region?
It is often nasal cavity/paranasal sinuses, so 1.2 Gy BID to 74.4 Gy and electively treat the neck. Otherwise 70 Gy/35 fx/30 treatment days SIB.
Are there any recommendations on ways to reduce capsulitis in patient with implants receiving adjuvant whole breast radiation?
There are no specific ways, but based on clinical factors, consider options to reduce volume of RT by PBI with EBRT or brachy, if the patient is suitable for partial breast RT. For whole breast, try to have good dose homogeneity like V105 in single digit (<10%), and with V110 as zero. Avoid any hot ...
Do you have a maximum size cutoff for lung SBRT in central NSCLC?
The bigger the tumor size, the lower the efficacy of SBRT. Typically, I wouldn’t treat lesion of size >7 cm for the following reasons: The local control is lower even with BED>100 Gy; There is high chance that the PTV overlaps with critical structures so toxicities could be high. There is high poss...
How would you manage a gastric MALT patient with anemia and peri-gastric and abdominal retrocaval nodal involvement?
Of course, I would first want to know if the disease was H. pylori+. Studies have shown that involved perigastric lymph nodes and deep invasion of the gastric wall are associated with a lower chance of achieving a complete response with triple therapy, but in most patients with gastric MALT (a very ...
How would you manage a bulky primary exophytic vulvar SqCC in a patient with uncontrolled but very long standing HIV disease?
I would first optimize HIV management and then plan for definitive RT (chemo) based on the CD4 count.
Do you ever offer spine SBRT for patients with multiple adjacent involved vertebrae?
Yes, multiple spine segments can be treated. NRG 0631 included 2 contiguous spine levels for radiosurgery/SBRT. An earlier study (Ryu et al., PMID 17167762) showed that the spinal cord dose tends to be slightly higher when the length of the target volume is >6cm. This was the basis of including 2 co...
What dose would you use for multifocal, recurrent, subtotally resected pleomorphic adenoma of the left neck salivary glands?
I would take it to 60Gy
Do you ever treat patients with phyllodes tumor of the breast with adjuvant radiation?
The risk of local recurrence is small for patients with benign phyllodes tumors treated with lumpectomy or mastectomy, even if there are positive margins. Recurrences are almost always benign. Hence, there is no role for adjuvant RT for such patients. The available literature does not allow one to d...