Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In your experience, is a bra worn during radiation treatment for large-breasted patients ever beneficial?
I have used styrofoam wedges in the infra-mammary fold to reduce the effect of skin folds. I would suggest placing these wedges in a fixed position with markings to help reproduce the position.It's also important to realize that in order to reduce the risk of treatment-related morbidity, one can als...
What is palliative RT technique would you use to treat a secondary lymphoma of the scrotum without skin involvement?
Technique depends on the dose being given and how the toxicities of that dose may affect the patient. If this is a low-grade lymphoma receiving 2 Gy x 2 or 2 Gy x 12-15 then I don't think the toxicity with a well planned 3D (with FiF as necessary to minimize heterogeneity) is likely to cause too man...
Would you ever initiate steroids during conventional lung radiotherapy in a patient who develops dry cough during treatment?
I have not yet done so, though I would never say never (perhaps worth considering if cough is very severe, if V20 or MLD is very high, and if one can see significant inflammatory changes on CBCT). Instead, I tend to treat the cough with typical supportive medications.
What is your PSA threshold for obtaining PSMA PET for biochemical failure after RP?
I typically order a PSMA PET after ~0.20. Sometimes lower if there are multiple aggressive features or poor prognostic factors (i.e. SVI with no lymph node dissection and persistently positive PSA of 0.15 after RP). This approach seems to be a reasonable threshold to me based on two considerations: ...
Do you recommend ADT for a high risk prostate cancer patient who had SBRT?
SBRT doesn’t mitigate benefit of ADT and the type and duration have to be the same as with EBRT or EBRT plus brachytherapy.
Is ultra-hypofractionation to the whole breast an appropriate adjuvant radiation treatment for Paget's localized to the nipple, status post central lumpectomy?
I would use the same principle as we use for non Paget's DCIS or IDC for use of ultra hypofractionation.
To obtain insurance approval for DIBH when treating left breast cancers, are there particular dose constraints to sites that you employ?
I am surprised insurance companies are still restricting the use of DIBH for left side breast cancer and need some metrics to support it. Mean dose to heart is low with DIBH as it helps to restrict scatter and transmission from conformal heart block and knowing each Gy to the heart matters, DIBH is ...
How would you manage a T2N0 anal squamous cell carcinoma in a patient with a history of FAP s/p remote proctocolectomy with J pouch creation?
This is a rare situation. The more common would be an adenocarcinoma developing in residual rectal mucosa after proctocolectomy for ulcerative colitis or FAP. If disease is locally advanced in those cases, and therefore an indication for radiotherapy, I’ve favored pre-op total neoadjuvant therapy se...
When would you recommend observation and withhold adjuvant RT in resected esthesioneuroblastoma?
I can’t think of an instance unless was an extremely early lesion with negative margins in an elderly, infirm patient. I haven’t seen it in over 40 years. Short answer, almost never.
How do you manage locally advanced adenocarcinoma of the base of tongue?
This is typically a surgical disease being minor-salivary gland, followed by adjuvant radiation therapy as needed. These do not normally respond to radiation therapy alone well at all. The question is what if the patient cannot tolerate or refuses surgical resection?