Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?
Unfortunately, this patient has a very poor prognosis. Due to the nature of her tumor being poorly differentiated, her disease is more likely than not to be refractory to radioiodine. If her disease in the thyroid and neck has not been addressed, external beam radiation therapy should be offered for...
Can a nonbulky, T1-2 supraglottic larynx cancer near the vocal cords be treated like a glottic tumor?
The supraglottic larynx and the pharynx, unlike the glottic larynx, share similar embryological origins and therefore exhibit analogous lymphatic drainage patterns to levels II and III. Therefore, occult dissemination to regional lymph nodes has to be considered regardless of the characteristics of ...
Do you use nomograms to decide whether to treat pelvic nodes in high-intermediate to high risk prostate cancer?
Rather than using risk estimate, my practice is to treat nodes for all high risk patients unless there is a contraindication. The nodal group I treat is distal common iliac, external, internal iliac, obturator and presacral region. The contouring principal is same for all pelvic malignancies and is ...
For a patient with stage IIB pure seminoma s/p orchiectomy who has bilateral RP adenopathy, do you also cover the contralateral iliac nodes in the dog-leg field?
I would treat ipsilateral pelvic node only Wilder et al., PMID 22436787
What is the role of GammaTile in the management of primary brain tumors and brain metastases?
GammaTiles are an intracranial brachytherapy product marketed by GT Medical Technologies consisting of a Cs-131 source imbedded within a collagen matrix. Proponents of the technology argue that advantages of GammaTiles over external beam radiotherapy techniques include the ability to “start” the rad...
Is it acceptable to use once daily fractionation for small cell lung cancer?
This question is still very relevant of further discussion. This particular poll and commentary began in June 2016! For the record, as of today I still prefer 45 Gy in 30 fractions delivered BID. For those that cannot come to treatment twice-daily, I use 60-66 Gy in 30-33 fractions based on OAR cons...
Do you consider ablative radiation therapy for oligometastatic colon cancer with 5 pulmonary lesions responding to chemotherapy?
The definition of oligometastatic colorectal cancer (OCRC) varies quite significantly. The European Society for Medical Oncology (ESMO) defines OCRC as having up to five lesions in no more than three metastatic sites but can sometimes have more if complete eradication is possible. There is no random...
What pentoxifylline and vitamin E dose do you typically use for both the prevention and treatment of radiation-associated fibrosis after breast RT?
Pentoxifylline 400 mg three times daily and Vit E 400 iU once daily.In a small retrospective review, tolerance to Pentoxifylline was improved with the use of concurrent antiemetic therapy. Of those on antiemetic therapy, 89% completed pentoxifylline as prescribed versus 48% of those without antiemet...
Do you offer memantine for patients undergoing PCI?
Extrapalating on 0614, I do use memantine for patients undergoing PCI. I do this for 6 months. These are patients that are expected to live even longer than brain met patients. And given the low toxicity, I think it would be rude not too (as one of my former students would say!)
Is there a role for prophylactic Trental and vitamin E in a patient at high risk for osteoradionecrosis?
Probably not