Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What protocols or safeguards do you implement if bed bugs are found on a patient or their belongings while on the treatment table or near equipment?
Typically once a bedbug is identified, the patient is brought directly into our inpatient holding bay so that there is limited time to contaminate common areas of the department. Therapists do utilize contact precautions including knee high shoe covers. We then have our hospital facilities team trea...
Would you treat a patient with metastatic castration resistant prostate cancer and prior treatment with Ra-223 with Lu-117-PSMA-617 therapy?
Yes, assuming they are otherwise eligible with PSMA + disease, acceptable blood counts, etc. In fact, in cases with patients with bone only disease, many argue to start with Ra223 rather than Lu117 as if they progress beyond bone only disease and are treated with Lu117, they will not be able to rece...
Do you offer adjuvant radiation for low grade spindle cell neoplasm of the breast after lumpectomy?
We need to qualify if it is benign or malignant phyllodes or some other sarcoma as the management principle is different. If is it low grade sarcoma, then can use the similar principle of sarcoma management and consider for adjuvant RT after lumpectomy (organ preservation approach).
How do you manage rectal or bowel perforation from interstitial brachytherapy needles?
One additional step I take other than the one highlighted is at the time of CT simulation if I notice that, I would pull those needles out either completely or to the point they are not into the wall of OARs.
In a patient with history of pneumonectomy would you consider SBRT for treatment of a new tumor in the remaining lung?
I've been pulled into this a few times and it is tricky. I think I've posted a few of my misadventures about this before (central tumor in a patient with pneumonectomy that died from SOB related to mechanical changes). However, I have done it successfully several other times and so I believe it's do...
How do you define bulky disease for Hodgkin's lymphoma which is outside the mediastinum?
Definition of bulk in lymphoma is not homogenous among countries, study groups, and diseases.Overall, 10 cm is considered the cutoff by some. Recently, the cutoffs of 7 or 7.5 cm have been introduced, especially in DLBCL. The definition tends to be disease-specific sometimes, since landmark studies ...
How would you approach an elderly patient with locally advanced breast cancer and co-morbidities, who strongly refuses surgery but is willing to consider radiation?
Presuming that this is nonmetastatic, if the local symptoms permit, I would prioritize starting with systemic therapy to cytoreduce, then treat with a hypofractionated regimen, with the understanding that this is a palliative approach if surgery is refused. This is (obviously) a very general "first ...
How do you fractionate prostate cancer where there was rectal wall infiltration by hydrogel after healing?
For superficial infiltration, I do not change approach. For deeper infiltration with delamination of muscle layers, especially muscularis propia, I typically switch to moderate hypofractionation (60Gy/20 regimen) and treat whole spacer gel area as part of rectum OAR. We have done this systematically...
What dose do you use for T2 anal squamous cell carcinomas measuring greater than 3cm?
These dose questions are very difficult to answer. 50.4Gy and 54Gy are both acceptable answers to this question. Most academic centers use their own data to justify the doses that they use. To give you an example, when I started my career at MD Anderson in the 3-D era, every patient got 55Gy. When w...
How would you manage a medically inoperable patient with an invasive squamous cell carcinoma of the oropharynx and extensive adjacent leukoplakia harboring pathologically-proven in situ disease?
Definitive chemo RT using hyperfractionation or SIB with weekly cisplatin. I would treat the CIS and reduce off of it at 64 Gy.