Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you account for treatment breaks longer than one week for patients with anal cancer receiving definitive chemoradiation?
I don’t think there is a “one size fits all” approach to this scenario and in general, practice is not supported by high level evidence. We do have a wealth of data to suggest that prolongation of the overall treatment time for squamous cell carcinoma (head/neck, uterine cervix, anal canal, etc) is ...
What personnel does your department require to safely deliver vaginal cylinder brachytherapy, other than treating radiation oncologist and physicist?
We have dedicated nursing staff and specialized brachytherapy radiation therapists who are all integral for all of our procedures, including vaginal cylinder brachytherapy.
Would you advocate for sphincter preserving chemoradiation therapy for a patient with a diagnosis of anal canal carcinoma who has previously been treated with pelvic radiation such as EBRT or brachytherapy?
The dose of the prior radiation is very important. If the sum is greater than 100Gy, there will be a risk of urinary or rectovaginal fistula formation. If the prior radiation was only adjuvant and there is a window of opportunity for definitive treatment. The acute reactions are no worse because the...
What dose and fractionation do you use for palliative radiotherapy of GI carcinoid tumor metastatic to spine/bone?
With all metastatic neuroendocrine tumors, given the generally good life expectancy (as compared to more common metastatic GI carcinoma), all therapy must be aligned to provide maximal local control and minimize side effects or other potential therapeutic options. While historically felt to be radia...
What is your target volume when treating lymphoid hyperplasia of the lacrimal gland with radiation therapy?
Agree with treating the lacrimal gland only. For a symptomatic, polyclonal reactive lymphoid infiltrate unresponsive to less aggressive treatments, I think low-dose RT is reasonable. I would give 2 Gy X 2.
For what patients are you adopting the PROSPECT approach into your rectal cancer practice?
Yes, the results of the trial are certainly factored into a multidisciplinary discussion. It is important to have a multidisciplinary discussion and to have shared decision-making with the patients. We often incorporate response to FOLFOX in this setting to decide. Although it is very subjective, we...
What dose do you use for postoperative rectum boost?
To the best of my knowledge there is no good information on this topic. I rarely use post RT nowadays. However, when I do, I have not gone higher than 54 Gy when it is truly an adjuvant treatment, and I often stopped at 50.4 Gy. The main limiting factor is toxicity, both small bowel and residual rec...
How do you manage early stage anal or anal margin cancer that is locally excised with negative but close margins when going back for wider margins would require an APR?
I've seen this scenario several times when a patient has an excisional biopsy (the surgeon doesn't think it is cancer) and leaves behind a positive or close margin. After properly staging the patient with pelvic MRI, I typically recommend adjuvant chemoradiation since they are at risk for recurrence...
What is your treatment approach in a patient with small cell lung cancer and a pericardial effusion?
KPS should be factored into all clinical decisions regarding patients with small cell lung cancer, regardless of stage. Age should be considered, but is not a contraindication to curative treatment in itself.The staging of SCLC is inherently subjective - "limited to the ipsilateral thorax and region...
Should radiotherapy be utilized in stage IVA NSCLC with a malignant pericardial effusion?
This has come up on occasions. I'm not aware of any high-quality evidence to guide one way or another. I would say, there may be a role for thoracic RT on a case by case basis. Though, I would preface all of this by stating that malignant pericardial effusion usually confers a poor prognosis.I assum...