Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose constraint, if any, do you use for the ureters during prostate radiation?
I have never changed the treatment volumes or applied a specific dose constraint. The ureters can sometimes be hard to see on CT, but contrast helps and this is something we don’t routinely do. The vas deferens is another structure we tend to ignore too. I think this will be an increasingly importan...
How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?
With respect to working up the enlarging lymph node, I agree with @Dr. First Last and @Dr. First Last above. If confident that this is seminoma recurrence, tumor markers normal, and if stage IIA or select stage IIB (select non-bulky, <=3cm) cases, our team advocates for radiation to the para-aortic ...
How do you manage disease progression during adjuvant chemoradiotherapy for glioblastoma?
Hospice.
Do you ever consider a dose constraint to the spleen when treating lung tumors with stereotactic radiotherapy?
Spleen-schmeen. :) Which is a non-professional way so say I think it’s okay to treat it. If you consider we used to remove them for Hodgkin Lymphoma, they are important organs but not crucial. If you’re treating a corner of it (which I have done many times) you will be safe IMO. It’s not hollow visc...
What factors would make you consider adding adjuvant radiation to the neck of H&N cancer after a negative dissection (pN0)?
If there is an indication for adjuvant radiation therapy based on NCCN defined "adverse features", I include both the primary site and the neck even if pN0. It is never possible for the surgeon to remove ALL the lymph nodes in the neck and there is always risk of microscopic involvement of the undis...
What approach have you found works best in treating persistent acute radiation proctitis in patients undergoing pelvic EBRT?
Obviously, this is an important question, though I'm a little unclear on the meaning of "persistent acute" radiation proctitis. Though I am not certain, I believe @Dr. First Last's answer applies more to chronic (or at least sub-acute) radiation proctitis. As for the more traditionally "acute" radia...
Do you always use a bolus when treating with postmastectomy radiotherapy?
It's important to note that today's PMRT patient (with her skin-sparing surgery and her tissue expanders and her small primary with just two nodes) is not the typical neglected/advanced ulcerated mess of yesteryear. I reserve bolus only for patients with high-risk for skin involvement (inflammatory ...
Would you offer prone APBI with IMRT/VMAT?
I am not sure one can do VMAT with a patient prone - I was told there are issues with gantry position and the table. As far as tangential IMRT, that is definitely possible and worth considering if you cannot meet homogeneity/V105 constraints. With prone breast, however, I rarely have any issues me...
Is it safe to administer Lu-177 therapies in patients with epidural disease in the spinal canal?
In general, yes, it's safe, but the specifics matter. The VISION trial excluded patients with unstable malignant cord compression. The lesson here is that if you have a developing malignant epidural compression, either cord or cauda, it should be dealt with urgently and separately from any considera...
How would you manage a Stage IV NLPHL that has residual hypermetabolic disease involving the bilateral neck/SCV following RCHOP x 4 cycles?
Nodular lymphocyte predominant Hodgkin lymphoma is an unusual disease, developing in ~450 patients each year in the United States. While the WHO classification still categorizes this entity as a Hodgkin lymphoma subtype, the International Consensus Classification refers to this disease as "nodular l...