Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat a patient who failed cryotherapy?
There is published data (small series), showing reasonable efficacy and good tolerence of salvage EBRT for cryotherapy failure and we have treated a few patients with this approach.
If a daily conebeam CT is done for prostate cancer treatments, do you subtract any treatment fractions to compensate for the daily imaging dose?
The radiation dose from daily imaging depends on techniques used. In most cases the dose of radiation is very low, relative to the dose delivered for treatment. Nonetheless, this dose is often delivered to non-targeted tissues and it is wise to minimize the dose and volume when feasible. From my phy...
What is your technique for CT and MRI fusion for external beam prostate planning?
We try to fuse prostate to prostate, knowing the limitations caused sometimes by bladder and rectal filling. Since the main advantage of MRI is to identify apex, base, and lateral edge, the fusion still helps in defining the prostate
What is the key to becoming an outstanding radiation oncologist?
I am not sure that my life experience qualifies me to answer such a big question but in attempting to give you my opinion I have drawn upon the behaviors and values of my mentors and others in the field who made a significant difference in the lives of their patients, colleagues, and students. If I ...
How often should you re-plan interstitial brachytherapy for gynecologic malignancies?
Ideally one should scan before each fraction to ensure needle position and account for changes in critical organ anatomy. That being said, because of logistic constraints we do QA before each fraction to check for needle displacement and if measurements are off by 2 mm or more, then we do rescanning...
What instructions do you give patients to optimize bladder filling and rectal emptying for GU and GYN simulation and treatment?
For prostate cancer treatment with external beam, IGRT is standard, so pretreatment localization of the target takes place. Because of IGRT, I don't recommend rectal filling/emptying instructions. To reduce bladder exposure, simulation and treatment with a "comfortably full bladder" is recommended.
How do you manage small oropharyngeal cancers with N1 or N2 disease?
For T1-2N1 oropharyngeal cancers there is data from MD Anderson and Toronto that they do quite well with RT alone. These patients are excluded from current RTOG chemo-RT protocols. It is possible that more advanced tumors that are HPV(+) in non- or remote smokers will also do very well with RT alone...
Do you use altered fractionation in patients with locally advanced head and neck cancers who are not candidates for chemotherapy?
yes
Is there a role for PET/CT in pancreatic cancer staging or treatment planning?
PET is not routinely used in pancreatic cancer staging or treatment planning. The current standard of care is a “pancreas protocol” (i.e. three phases of contrast and thin cuts) CT. MRI can also be helpful.
How do you control for organ motion when treating pancreatic cancer?
Typically I use a forced breath hold to essentially eliminate motion so that setup variation is all that we have to deal with after delineating a tumor on CT.