Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat a parotid Warthin's tumor in a medically inoperable patient?
By "medically inoperable", I would assume life limiting co-morbidities and/or poor KPS. In this situation if the tumor is asymptomatic (and only incidentally detected), I would not offer any treatment. Given that Warthin's tumors have an indolent natural history, it would be analogous to an indolent...
When (if ever) do you consider radiation therapy as adjuvant treatment for GIST?
I would NOT consider radiation as adjuvant treatment for GIST. A diagnosed GIST tumor is standardly treated with Imatinib as medical therapy in the first line. Resistance to Imatinib or genetic variations may cause slight modifications to this therapy, however I have not used RT in the adjuvant sett...
What is your dose-fractionation for cylinder-based vaginal cuff HDR brachytherapy for an isolated vaginal cuff recurrence after whole pelvis EBRT with residual thickness of disease <5 mm?
I usually prescribe 5Gy x5. I don't prescribe to a fixed thickness but treat based on residual thickness seen on MRI using multichannel applicator.I lesion at apex then treat upper 2-3 cm of vagina Here is out paper describing technique and outcome in detailhttps://www.ncbi.nlm.nih.gov/pubmed/299299...
What dose do you use to palliate multiple myeloma in a vertebral body?
For ISS Stage 1 MM patients who are going to have an OS of over 10 years, I generally prefer a more protracted regimen of 25 Gy in 10 fractions for improved durability of pain control. I typically only treat the symptomatic VB only and use inverse planning. If there is gross epidural disease or cord...
Does your choice of dose and fractionation for bone metastasis depend on the location of the metastasis in question?
Actually, at this point, I've pretty much gone to 400 cGy x 5 fx for most everything, with the exception of really nasty disease where I might do an SIB to the GTV to 500 x 5 while the PTV gets 400 x 5, or someone going straight from XRT to hospice where I'd give 800 x 1. I still have a gut feeling ...
Are there any special treatment considerations when treating a patient with laryngeal cancer with significant Reinke's edema of the vocal folds?
If possible, I would collaborate with the ENT/ORL who diagnosed Reinke's edema. Reinke's is often from smoking and then I'd counsel smoking cessation. Sometimes it can be from reflux or hypothyroidism - so treat that if that's the issue. I would also be sure you are confident of the local extent/sta...
How would you approach an isolated supraclavicular nodal recurrence involving the skin in a patient who has received standard chest wall and nodal radiation therapy?
Very challenging situation. Assuming it has been a few years out from the standard RT, and that the nodal mass is in relatively close proximity to the brachial plexus (as it cannot be too far), I would consider: Repeat external beam RT, hyperfractionated to increase the therapeutic ratio (i.e., redu...
How can I maximize my efficiency in the clinic?
I have found that my time is better spent if I: 1. Get in an ~hour before official work schedule time period. 2. See all my OTVs on Mondays (or Tuesdays for holidays). I found that seeing them on Thursday or Fridays allows for more visits on the following Monday because of weekend issues. No simulat...
How would you approach unexpected chemo breaks during planned neoadjuvant chemoradiation for esophageal adenocarcinoma?
Local regional failure compromises quality of life
Does low Decipher score alter your duration of ADT for a high risk prostate cancer patient?
This question contains a few very important concepts that I think most of us were not trained to appreciate (I wasn't) that I will try to expand on: What truly is an NCCN risk group and what is its importance? How to incorporate more accurate prognostic biomarkers? While it may sound odd to some to...