Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage thrombocytopenia when radiating the spleen?
Radiation oncologists are occasionally asked to see patients with symptomatic splenomegaly (early satiety, dyspnea, and pain) and evaluate for radiation therapy. Many such patients have non-functional bone marrow from diseases such as primary myelofibrosis. This leads to extramedullary hemoatopoiesi...
How do you interpret PSMA/PET with focal prostate activity after XRT currently on ADT with stable PSA?
The most concerning element of the case presented is that the patient’s PSA continues to be ≈ 5 while on ADT with presumably castrate levels of testosterone, which should be verified. The current PSA is one order of magnitude greater than would be expected from the effect of ADT alone possibly indic...
For patients with RCC or other radio-resistant histology with metastasis to long bones requiring surgical stabilization, what dose and volumes do you use for post-op RT?
Recent data from Sloan Kettering suggest that covering the entire hardware allows for better local control. I would stick with 30 Gy in 10 fx, if treating post-op. Can consider 1 or 5 fx, but since this is less for pain and more for local control, I would fractionate.
Would you electively treat any lymph node regions for small cell carcinoma of the pancreas?
In general, we model treatment for these patients on the regimens used for SCCa of the lung. The most important thing to establish is that non-operative management is the preferred approach due to the risk of distant metastases. In general, the value of elective nodal treatment is inversely proporti...
When treating a bulky squamous cell carcinoma of the anal canal, do you try to limit the dose to the external anal sphincter to any particular number to reduce the risk of chronic fecal incontinence?
No
What cardiac surveillance would you do for an asymptomatic male patient with a remote history of mantle field radiation for Hodgkin's lymphoma?
I would follow the long-term follow-up guidelines from COG based on heart dose - Children's Oncology Group (survivorshipguidelines.org)
Would you cover regional nodes in an early-stage breast cancer with a non-mapping sentinel lymph node?
Based on the SSO Choosing Wisely Guidelines (https://www.surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdf) to not routinely use SLN biopsy in clinically node negative women ≥70 years of age with early stage hormone receptor positive, HER2 negative invasive breast canc...
Would you offer consolidative full dose chemo-RT for local residual pancreatic disease in a patient with stage IV pancreatic adenocarcinoma with excellent response after induction chemotherapy?
I think radiotherapy can selectively be considered in patients like this. The potential roles of radiation therapy could include: Palliation of local symptoms. RT is very effective at palliating symptoms such as pain related to celiac plexus infiltration, etc. Lawrence et al., Journal of Clinical O...
Would you compromise target coverage to meet OAR constraints for prostate radiation?
Median lobes can sometimes be challenging. There are a few options in this scenario. First, and most simply, ensure your bladder is comfortably full for simulation. Most IMRT bladder constraints are volumetric, so larger bladder sizes make meeting constraints easier. Second, if the median lobe is c...
When giving concurrent chemoradiation therapy, is it important that the infusion be prior to RT as opposed to after RT?
Radiobiological data suggest better cell kill when cisplatin is given before RT and then given after (1.7x vs. 1.2x) and similarly when delivered daily vs when delivered weekly. In practice, for that reason, we do it before RT and early in the week (Monday or Tuesday). The ongoing cervix OUTBACK tri...