Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
What is your preferred regimen for palliative treatment of unresectable retroperitoneal sarcoma?
First, I’d distinguish: 1) If the goals are PURELY palliative, can pick a conventional (30/10) or more adventurous (39/13, QuadShot, etc) palliative regimen - there is a separate MedNet thread on dose/fractionation for sarcoma palliation. But efficacy and durability are likely limited. 2) If the pri...
How often do you utilize intrafraction motion tracking when treating prostate cancer?
Why not?
Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?
This is an important question with implications for both overall survival (OS) and quality of life (QOL) where level-1 evidence is currently lacking. It is also the subject of an ongoing phase 3 trial (SWOG S1827/Maverick) that randomizes patients with limited-stage (LS) and extensive-stage (ES) SCL...
In a patient with T2N0 breast cancer with skin involvement s/p lumpectomy and negative margins, if you are offering whole breast radiation, would you bolus your tangent fields?
I tend to use small bolus over the scar area in this setting
What dose do you typically prescribe to the primary tumor for definitive treatment of squamous cell carcinoma of the anal canal (given concurrently with chemotherapy)?
I just saw this and wanted to comment about the microscopic dose. I think the doses that are "standardly" used to treat "microscopic disease", such as those recommended by Chris Crane, are too high. One needs to remember that the original Nigro regimen used doses of 30 Gy to gross disease and had go...
Would you recommend adjuvant radiation to the breast for low grade adenosquamous carcinoma after lumpectomy?
There is scarce data on these rare histologies. With lumpectomy given the uncertainties, I would offer radiation. This is likely triple negative as well. The latest guidelines on whole breast fractionation from ASTRO suggest that in these rare histologies that usually arise in other parts of the bod...
What are the realistic, modern 10-year survival curves for localized prostate cancer given the improvements we have made in diagnostics and treatment?
Generally, outcomes are excellent for the average patient with localized prostate cancer. As all-cause mortality is driven by competing risks for patients with localized prostate cancer, the age and overall health of a patient are often the most important prognostic factors to predict overall surviv...
In which patients with early stage rectal cancer treated according to the PROSPECT paradigm do you recommend adjuvant chemotherapy?
Great question and great observation. The most recent NCCN guidelines (version 1.2024-page REC-6) clearly listed neoadjuvant chemotherapy without radiation as an option for patients with no T4 disease eligible for sphincter-sparing surgery. After the neoadjuvant chemotherapy, if tumor regression is ...