Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How does the recent publication of RTOG 0813 affect your management of centrally located lung tumors?
RTOG 0813 s a very valuable data set. This was the first trial using the TITER method performed within NRG Oncology (formerly RTOG). When 0813 was written, we fully expected there to be more toxicity events than were actually experienced. Please remember that we did not limit dose to central structu...
Does proximity to or involvement of the aorta effect the dose and fractionation you use for an early stage NSCLC?
In the primary treatment setting I think it's very safe as long as you adhere to the constraints used in RTOG 0813 (105% to 0.03cc) since this would be considered a central tumor. I have never seen a complication from treating the aorta using those constraints in the upfront setting. Retreatment is...
In what situations would you omit craniospinal irradiation in a patient with a pineoblastoma?
I think in general, for pineoblastoma, the treatment paradigm has been for craniospinal radiotherapy due to risk of craniospinal seeding. I would take into account the extent of resection, age, spinal disease, etc.
What is your approach to managing asymptomatic ORN of the mandible?
Do nothing until you have to.