Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose constraints do you recommend for the heart when treating an intrahepatic cholagiocarcionma with ablative (15 fx) techniques when the tumor is adjacent to the right atrium?
This is a really interesting and great question. The primary considerations for heart dose are prognosis from the cancer in the best case scenario and the risks of subacute and late toxicity. Since the 5yr OS even of resected IHCC is only 25%, that is the best case assumption for ablative RT. 70% of...
Do you use bite block during radiation treatment for base of tongue (BOT) cancer?
Yes, we use intra-oral immobilization for any tongue (or BOT) involvement.Japanese data suggest improvements in immobilization lead to clinically meaningful PTV implications (Doi et al., PMID 28515675) in head and neck cancers. Our in-house data suggests not having a stent on a BOT target requires a...
What is the appropriate dose of radiation for a primary osseous non-Hodgkin's lymphoma?
Acceptable doses range from 30 Gy to 45 Gy. Would consider 30 Gy if there is a metabolic complete response after 2 cycles of R-CHOP and the patient got at least 4 cycles total. 45 Gy is the dose used in the prospective TROG trial of bony DLBCL, so it has some data behind it. In the femur, the bigges...
Would you give pentoxiphylline and vitamin E during HBO for vaginal necrosis?
My usual approach to treating radiation injuries in the pelvis would be to start with Vitamin E (Vit E) and pentoxifylline (PTX) for less severe radiation-related injuries, but in cases with ulceration and/or necrosis or bleeding requiring transfusion to proceed directly to hyperbaric oxygen (HBO). ...
How do you instruct patients taking sucralfate?
I have been prescribing carafate for many years now and to this day I don't know if it helps patients or if compliance is possible. I would be curious to know what the experts think.
Are there any contraindications to treating early stage breast cancer with radiation in patients on rituximab?
I have treated patients with RT and retuximab with no increased acute morbidity whether efficacy would be compromised is not known
How would you approach treatment of a brainstem AVM after hemorrhage in a patient not a candidate for surgery or embolization?
The question posted is a challenging one.First of all, one has to wait, after a bleed, for all the blood products to disappear before an angiogram to have a good idea of the nidus in terms of location within the brain stem, size, and geometry. The patient’s neurological status after a bleed in the b...
If a PET/CT scan is positive for mediastinal lymph node involvement, is a mediastinoscopy or EBUS still required for NSCLC staging?
The gold standard for mediastinal staging is still mediastinoscopy. You can have 15 to 20 percent false positive PET findings in mediastinum and for these patients surgery should not be excluded based on PET findings alone.
How would you approach a subcutaneous oligometastatic uterine carcinosarcoma?
Systemic treatment. For local, based on response to systemic, can consider local excision or hypofractionation with a schedule like skin cancer.
What is the age cut-off to omit radiation therapy after breast conserving surgery for early stage breast cancer?
I agree with the above answers and would like to expand a bit. What is so special about being over 70 (or over 65 for that matter) when your breast cancer is diagnosed? Not much. Age is a rough surrogate for life expentancy and perhaps also for biologic subtype. But we have SEVERAL trials across bro...