Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage EBER positive (non-keratinizing) SCCa of unknown primary in the head and neck?
CRT alone as long as neck disease is not multi-level, large, or in the lower neck. I would include bilateral nasopharynx, bilateral RP nodes, and node levels II-V bilaterally.
How do you explain fleeting, post-RT breast pain to patients, and what do you recommend as management?
It is common, underreported, and appears to be nerve related. I recommend assurance as intensity and frequency improve with time.
What radiation fractionation scheme would you use to palliate a patient with metastatic paratesticular leiomyosarcoma limited mainly to soft-tissue sites as well as the scrotum?
Same as other palliative treatments - 300 cGy X 10, 400 cGy X5...
What dose/fractionation scheme would you employ to palliate a metastatic colon cancer patient with several large painful anterior abdominal wall lesions?
Due to the prior surgery, there is almost always fixed bowel adherent to these scar/peritoneal recurrences. That is almost always the dose limiting OAR. The fractionation depends on the PS and life expectancy. From the description, the prognosis sounds poor so 20 Gy in 5, 30 Gy in 10, or 35 Gy in 14...
Should immune checkpoint inhibitor be held for palliative RT to bladder in patient with metastatic urothelial carcinoma who has stable systemic disease on immunotherapy?
I assume the scenario applies to patients with good systemic disease control on immune checkpoint inhibitor (ICI) but with symptomatic primary tumor of the bladder, e.g. hematuria, pain, and obstruction. It is helpful to have a good discussion between Med Onc & Rad Onc regarding the optimal timing, ...
What are your recommendations regarding sexual activity for a couple when one of them is diagnosed with a HPV-positive oropharyngeal cancer?
We always counsel patients regarding the etiology of HPV if they have a p16+ tumor. We tell them that this is an infection most likely acquired through sexual activity and that the latency period is approximately 20 years from the time of exposure until the time of a cancer diagnosis. We note that o...
How do you create the boost fields for a definitive bladder cancer treatment?
"Map out the tumor position three dimensionally with the urologist and use all available imaging" is what they say and then after locating it/contouring it, you have to treat with a full bladder. Early in my career, I attempted this and had two issues: Localization is harder than you think. If it...
For Siewert 3 locally advanced GEJ adenocarcinoma, when do you offer preop chemoradiation (CROSS regimen) vs periop chemotherapy (MAGIC or FLOT)?
Siewert I/II GEJ adenocarcinomas are treated according to esophageal cancer algorithms, while Siewert III GEJ adenocarcinomas are treated according to gastric cancer algorithms. Consequently, perioperative chemotherapy with FLOT is the standard, evidence-based approach for fit patients with Siewert ...
When treating sialorrhea in ALS patients, what treatment schedule do you use?
This is what our institution does. I utilized this a few months ago. Kasarskis et al., PMID 21726879
Would a patient receiving intravitreal avastin have a contraindication to prostate radiation?
There may be some systemic effects but not enough for us to hold adjuvant RT.