Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach a patient with symptomatic spinal cord compression who is a poor surgical candidate and has a radio-resistant primary tumor?
Radiosurgical decompression of metastatic epidural spinal cord compression has been demonstrated (Ryu et al., PMID 20209611). In this report, significant decompression was achieved in 80% of the patients. This decompression is assessed in 2 months' MRI scan since radiosurgery takes time for tumor co...
Would you recommend biopsy of a bone met noted on PSMA PET after definitive prostate radiation?
There is no simple answer to this. The following are some relevant considerations: What was the original risk category? What was the Gleason score? What was the pre-treatment workup? Was there anything noted there previously? Was or is the patient on ADT? Pre-treatment and current PSA values? How l...
What is your simulation setup and dose fractionation for DLBCL of the hand with Deauville 4 residual disease following R-CHOP?
This is a difficult question which I will break into 2 parts: 1) Rx of primary refractory (i.e. chemotherapy resistant) localized DLBCL and 2) special considerations for a hand site. I presume the recurrent/persistent disease is still localized.Treatment of primary refractory DLBCL is a very difficu...
Do you employ a phrenic nerve dose constraint with conventional fractionation?
No.
When planning prostate brachytherapy, do you use a bladder neck constraint?
With real time planning, try to limit it to 85 percent of the prescription dose. Smith et al., PMID 20888139
When considering omission of elective nodal irradiation in the post-op head and neck bilateral dissected pN0 setting, what is considered an "adequately" dissected neck?
20 or more nodes per side.
How do you approach RT coverage of an abdominopelvic lymph node in the oligometastatic or oligorecurrent setting?
Speaking specifically about prostate cancer, after treating a number of these with SBRT and having them fail in an adjacent node, me and everyone in our group will tend to treat the entire nodal chain with an SIB to the grossly involved LNs. The only exceptions are in those patients where prior RT p...
How would you approach a laryngeal adenoid cystic carcinoma in a patient seeking larynx preservation?
This is a rare case scenario (laryngeal ACC) in a rare cancer (ACC) of an uncommon group of malignancies (primary salivary gland malignancies) for which direct evidence is sparse. I would, therefore, approach with some general principles and a generous pinch of salt in this scenario. The initial tre...
In uterine cancer, how does positive peritoneum biopsy influence your recommendation for adjuvant RT?
It is stage IV disease and routine value of any adjuvant RT is very limited.
How would you treat a bladder cancer with rectal invasion with radiation?
In general, it may be difficult to achieve durable control with chemoRT alone for such a locally advanced T4 cancer such as this, and the patient may be better served with neoadjuvant chemo, restaging, and cystectomy, if this is feasible. If he is not a candidate/refuses cystectomy, would treat the ...