Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How do you define central lung cancers when considering SBRT?
Interestingly, I have never fully subscribed to the 2.0 cm "no-fly zone" concept and it was based on the need to ensure the safety of patients in our early experience. If one looks at the literature, the original All-Japan study did not differentiate between central and peripheral locations. The ori...
When giving hypofractionated ablative doses of radiation for cholangiocarcinoma, do you give concurrent Xeloda or hold chemo during radiation?
There is no direct evidence to answer this question. In general I have recommended giving concurrent capecitabine because I use a low dose PTV (BED of 50 or so), a high dose PTV (BED of 100 or so)... and sometimes also an ultra high PTV (BED 150 or so) in the center. The high dose PTV often has to b...
Should I use PET/CT for GE junction treatment planning?
I consistently find PET scans very helpful for defining the extent of disease in GE junction tumors.
How does your treatment of lymph nodes change for a breast cancer with limited (<2mm) vs more extensive ECE?
Extracapsular tumor extension (ENE) alone does not appear to increase the risk of axillary failure following axillary dissection (1, 2). There have been conflicting data on whether ENE increases the risk of local-regional failure (LRF) and whether the degree of ENE is important. Having ENE of 2 mm o...