Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should methotrexate be stopped prior to radiation therapy if a patient has rheumatoid arthritis?
I have not stopped as dose of MTX for RA is low (7.5 mg) and there is data of CMF with RT for breast cancer with higher dose of MTX showing no significant increase in morbidity.
How would you manage a cardiac metastasis from Merkel cell carcinoma?
I would first determine the extent of metastases and carefully determine the extent of the tumor in the heart (usually with cardiac MRI). I would also discuss the threat of the tumor to the heart with a cardiologist (if possible). If extensive metastases were present, I would suggest starting with i...
Is there any increased risk with adjuvant breast radiation for a patient with muscular dystrophy?
I don’t see any contradiction with dystrophy.
Do you still order mpMRI for staging of prostate cancer in addition to PET-PSMA?
Yes, I still think the prostate MRI adds valuable information for target delineation and local staging. This position is consistent with a recent poll of GU specialists where about 90% of respondents believed that a prostate MRI was still necessary after a PET/CT (Gillessen et al., PMID 35450732).My...
Do you have recommendations after prostate RT for patients who want to conceive?
This conversation has two directions based on whether or not the patient currently can produce semen. Assuming he currently canNOT produce semen obtained via ejaculation, I would refer him to a urological specialist for surgical extraction of sperm. From that point, the sperm could be inspected by a...
What are your top takeaways in Gyn Cancers from ASCO 2024?
ASCO 2024 was a quiet year for the gynecological cancer community without too many fireworks. For the radiation oncologists, there were very few positive studies. I will highlight a few important ones 1. Oral abstract #5504 was on “Adjuvant chemotherapy following concurrent chemoradiation (CRT) in p...
Does your dosimetrist use skin flash for VMAT whole breast or RNI plans?
We do routinely to account for set-up uncertainty and intrafraction motion. With VMAT, the auto flash features are built in but with VMAT, use virtual bolus technique.
What techniques do you use to address fertility preservation in young female patients being treated with chemoradiation therapy for cancer in the pelvis?
The most important aspect of a fertility preservation strategy is to think of it early on in the discussions with your patient. Many medical centers now have a clinic or center to which patients can be referred and seen within several days. They are experts at explaining the options and outcomes wit...
Is 3D non-coplanar conformal radiotherapy preferable over arc therapy for lung SBRT?
To build on @Dr. First Last insights, which I appreciate very much, I want to note that for those who have been doing SBRT for some time, VMAT delivery is a relatively recent development that, as mentioned, may enhance the patient experience from the delivery standpoint. At Cleveland Clinic, we have...
How would you manage a local recurrence of a spinal hemangioblastoma following prior surgical resection alone?
Hemangioblastomas are benign rare tumors that arise from the linings of blood vessels (embryonically arrested hemangioblasts) and can form in the brain, spinal cord, and retina. When they occur in the spine, they have a tendency to recur ~25% of the time. The primary treatment for a recurrent spinal...