Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does acute radiation cystitis cause microscopic hematuria and pyuria?
Radiation cystitis is the diagnosis.
How do you approach a urethral carcinoma s/p non-oncologic resection?
I have treated a few of them. It usually tends to be clear cell histology. For a non oncologic resection, I treat with chemo RT and have had mixed results.
What criteria do you use to determine the resectability of mucosal melanoma of the H&N region?
Obviously, the best specialist to answer the posted question would be a H&N surgeon. As a Rad Onc enthusiast who conducted a retrospective study about the subject long ago (Lee et al., PMID 8302112), I’ll provide my own 2-cents here:Mucosal melanoma (MucMlnm) of the H&N is a relatively uncommon mali...
Do you have any precautions to your injury to the uterine artery when placing interstitial needles as ‘ovoid extenders’ to cover parametrial disease in cervical T&O procedures?
When using oblique needles, it does come close to parametrial vessel, and the risk of bleeding is increased. Some use Doppler ultrasound to identify and avoid needles in vessels. What we do is tend to usually not push the oblique needle beyond 2 cm and adjust later on CT if needed and take precautio...
How do you approach hormone replacement therapy for premenopausal patients following pelvic radiation therapy?
Most patients who undergo pelvic radiation will become menopausal. Physiologically, the outcome is similar to surgical menopause because sufficient doses of radiation result in complete loss of ovarian function. In contrast, after natural menopause, the ovaries continue some types of endocrine funct...
If using hyperthermia in breast reirradiation, what type of protocol do you follow?
There are a few options we consider when using hyperthermia Hyperthermia and RT are given twice weekly, ex. 32-40 Gy/8-10 fx with hyperthermia Daily RT with twice weekly hyperthermia- 40/15, or 50/25 for example, with twice weekly hyperthermia. Sometimes consider concurrent capecitabine as well.
What is the role of local control +/- whole lung irradiation in a patient with relapsed/refractory Ewing sarcoma to the hilum plus multiple lung nodules?
I would boost residual thoracic disease to at least the usual Ewings gross disease dose of 55.8 (total, including WLI dose). Doses in this range are well known to be safe in the thorax and this multiply relapsed disease is likely to be more treatment refractory than primary disease. SBRT boost seems...
Is there any reason to hold fulvestrant during SBRT to an oligoprogressive nodule?
No.
For cervical cancer intracavitary brachytherapy, do you use contrast when using CT-based planning to better visualize the ureters?
We normally do MRI based planning and the ureter can be identified and contoured on MRI. For only CT based, we do out diluted contrast in bladder for bladder contouring but do not go to the ureter. Rodríguez-López et al., PMID 33065181Koerner et al., PMID 34980569
How do you prefer to manage multiple or numerous symptomatic skull metastases in a patient without brain metastases?
If it is painful, I would locate the areas that appear the most painful and "spot weld". I.e. - if there is a constellation of lesions on the right temple that can be encompassed with an electron field, I would treat that. Or, around vertex and can possibly do tangents. If there are virtually all o...