Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage grade III oligodendroglioma?
Given that these tumors predominantly occur in younger adults, and are often slowly progressive, there is an easy tendency to become complacent about the long-term behavior and outcomes with this disease. The bottom lines with this tumor are as follows: The diagnosis is complex, and often difficult,...
How do you define an adequate EBUS when staging NSCLC?
Important question. There is a high degree of variability in the diagnostic performance of EBUS based pretest probability of disease, physician experience and skill, quality control, and evaluation skills of the cytopathologist. Nice consensus guidelines from CHEST was published a few years back det...
Are there any special considerations when treating a patient with anal cancer who has poorly managed HIV/AIDS?
In the early days of AIDS, prior to the development of HAART, standard chemoradiation ("Nigro") was very poorly tolerated, and it was necessary to omit or dose-reudce the mitomycin, and many patients could not tolerate the full dose of radiation, stopping treatment early because of toxicity. Outcome...
When treating prostate or other pelvic malignancies, what dose constraints do you use for the sigmoid colon?
The data on cervical cancer RT with EBRT and brachy uses same constraints number for rectum and sigmoid (<65 -70 Gy to 2cc) . The corelation of sigmoid dose to toxicity is less as it is more forgiving because of organ moton. Dosimetric number which one reports is worse case scenerio not accounting f...
How do you manage recurrent atypical meningiomas in patients who have previously received radiotherapy?
This question, I fear, requires some underpinning. A recurrent atypical meningioma is an aggressive tumor, more so that than appears to be appreciated broadly. Even between first and second recurrence, as shown in a study by Bagshaw and colleagues at the University of Utah (Neurosurgery 126:1822–1...
How do you treat patients with single/solitary brain metastases who undergo resection after failing SRS?
Because of the difficulty in distinguishing between true tumor recurrence, radionecrosis, and a mixed radionecrosis/tumor recurrence picture, if possible we prefer to approach these surgically. If the recurrence can't be resected, these are patients that are referred for biopsy + LITT (laser induced...
What dose and fractionation do you use for gynecomastia prophylaxis?
As I answered on a previous thread to a question that was similarly posed, philosophically I would prefer electrons (less integral dose/more focused - IMHO) as opposed to photons. In terms of dose, it seem these days less is better with single fraction especially. Hence, the NICE (European) guidelin...
How do you approach management of limited stage SCLC in a patient with idiopathic pulmonary fibrosis?
I've seen a few patients with IPF and small cell. The concern is always that these patients have an underlying pro-inflammatory lung condition that makes them more prone to pneumonitis. My preference in this specific group is to give and complete chemotherapy first and then restage the patient. Sinc...
How would you approach an early stage p16+ SCC of the tonsil s/p TORS and neck dissection with initial positive margins but then negative on re-resection?
Postop RT
Is day 43 cisplatin 100mg/m2 needed after completion of RT in case of a delay related to neutropenia for locally advanced head and neck cancer?
Based on the retrospective post hoc analysis from RTOG 0129, two cycles of HD cisplatin in the accelerated fraction radiation treatment arm and two cycles of HD cisplatin in the standard fraction radiation arm were equivalent to 3 cycles of HD cisplatin when administered with RT. (Nguyen-Tan et al.,...