Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
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...
Do you use any thyroid dose constraints for head neck radiation planning?
I do not constrain the thyroid. Careful monitoring post-operatively for hypothyroidism and appropriate thyroid replacement is reasonable. There is another, more theoretical concern that I have in that based on a Childhood Cancer Survivor Study Analysis, intermediate RT doses to the thyroid (10 - 30 ...
What dose would you use to treat unresectable basal cell carcinoma of the vulva?
I would make sure not mixed pathology like basosquamous. If pure basal then would treat primary alone with dose and volume like BCC of skin.
Will you treat brain mets with SRS in patients who cannot undergo MRI?
I agree with all of the previous comments. In addition, I'd like to add my own anecdotal experience. I saw a patient with widely metastatic melanoma who underwent head CT instead of an MRI brain due to the presence of pacemaker. There was a nodular enhancing focus read as suspicious for metastasis, ...