Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage the contralateral neck and adjacent structures for a glossotonsillar or glossopharyngeal sulcus primary cancer if well lateralized?
The glossopharyngeal and glossotonsilar sulci are the grooves between the lateral oropharyngeal wall or the tonsil and the base of the tongue, representing a very lateral OPC location that does not require contralateral neck RT. The main neck nodes at risk are II and III. In the absence of significa...
How long should patients wait before undergoing reconstruction following PMRT?
Our approach is to wait for 6 months, which is based on the preference of plastic surgeons. There is published data showing a higher risk of complications if done sooner than 6 months and this forms the rationale for that wait.
Given the different rates of testosterone recovery, do you alter the duration of ADT when using Leuprorelin (GnRH Agonist) vs relugolix (GnRH antagonist) in patients with intermediate or high-risk prostate cancer who received definitive radiation?
To my knowledge, there is no definitive answer to this question, and I think the vast majority of providers do not alter their recommendations for duration. A brief discussion of the issue and some evidence is offered below, for anyone interested. A recent review in the Red Journal (Roy et al., PMID...
How do you manage prostatic adenocarcinoma after a subtotal resection?
This is a complex question with many permutations, and a review of the operative note in addition to the surgical pathology can help to inform clinical decision-making. Direct discussion with the surgeon, when possible, is also important because presumably there is some reason this occurred, which m...
How would you manage a patient with micrometastatic node positive tumor post mastectomy (no neoadjuvant chemotherapy)?
Currently, I don’t offer PMRT for T1 and T2 disease with micromets unless triple negative or a multitude of adverse factors Mamtani et al., PMID 28429197
Is there really substantial evidence to avoid central lesions for SBRT?
Much has been learned since the cautionary data from Indiana University was published showing increased toxicity when using SBRT for centrally-located lung cancers. One should be aware that there is an increased risk when treating tumors in this location with SBRT fractionation schemes. I am aware o...
Do you place any constraint on Dmax when developing plans for linac-based SRS or SBRT?
Very rarely. I was a gamma knife SRS person before I started linac-based SRS so I am very comfortable with >120% hot spots. For brain linac based SRS we regularly push hotspots to 150% to get the steepest dose falloff (most similar to gamma knife plans prescribing to the 50% isodose curve). For body...
How would you treat a synchronous anal canal squamous cell carcinoma and localized high risk prostate adenocarcinoma?
The primary anal cancer and prostate cancer can be treated with a whole pelvic field to include the anus and prostate/SV (45-50 Gy) with a simultaneous integrated boost for the anal tumor (RTOG 0529). HDR brachytherapy can then be used to boost the prostate after a short recovery from the external b...
Are you using vaginal dilators during treatment of rectal cancer to spare anterior vaginal wall, or are you reserving this for anal cancers?
We are using vaginal dilators for any woman with anal cancer or rectal cancer who desires to be treated with one. This is most impactful when the dose is being delivered to the distal vagina, near the introitus, but we do not have data to determine a cutoff. Of course, many rectal cancers require tr...
For a patient with T3N1M0 esophageal adenocarcinoma, who suffered esophageal perforation necessitating metallic stent placement, would you favor a neoadjuvant chemoradiation or perioperative chemotherapy approach?
In situations of esophageal perforation, the main concern will be the dissemination of disease particularly in the thoracic cavity, i.e. pleura. Therefore, I favor a systemic therapy approach upfront. Should the patient have a good response to systemic therapy, then chemoradiation could be considere...