Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend adjuvant radiation therapy for resected spine metastases in NSCLC with targetable mutations?
I would offer adjuvant RT. We have no data to guide us on whether targeted therapy alone would suffice. Moreover, given that the patient had resection, most likely there was some level of cord compression involved. Would hate for that to happen again after resection with suboptimal adjuvant therapy....
How would you treat bilateral synchronous breast cancer with single bony metastatic disease on imaging when one is ER+ HER2 neg and other is TNBC?
I will make some general statements, but lots of "depends" that you, the patient, and your team must discuss and decide. Firstly, it is important to biopsy this single site to determine which breast cancer has metastasized. It is also important to recognize that although you see "a single bony metas...
Would you consider re-irradiation for recurrence of Dupuytren's Contracture?
I have, in fact, re-treated one patient about two years after the first course because some nodules were progressing. I did a limited electron field with bolus to cover just the affected area and gave 200 x 10. Things seemed to stabilize after that. I would not treat a third time, however, but I hav...
How would you approach HDR portion of cervical SCC with large area of fistula with sigmoid colon?
Consider using ultrasound every time a tandem is inserted or a Smit sleeve placed under ultrasound guidance (if not already part of routine practice) for tandem guidance, to ensure that a false tract into the fistulous bowel is not produced at the time of tandem placement. Otherwise, as noted by Dr....
How do you approach external beam RT to the thyroid bed for resected recurrent thyroid cancer in a patient with previous history of 150mCi of radioactive iodine?
This is a terrific question and speaks to ALARA; I know of no data or dosimetric capacity to accurately estimate a biological effect (dose-wise) from an unsealed radiopharmaceutical on OAR. Keep in mind that dose limits for I-131 are due more on bone marrow toxicity than local effects. Previously, w...
Would you offer definitive radiation for a T1N0 glottic larynx SCC in a patient with a history of RAI treatment?
Absolutely
Is it safe to deliver palliative radiation to the spine with a spinal stimulator device in place?
There are 3 components in a spinal cord stimulator, the electrodes that are implanted in the epidural space, the implantable pulse generator, and the wiring connecting the two former components. The implantable pulse generator is similar to a cardiac pacemaker and it is the most important component ...
What isotope and dose do you prefer for prostate brachytherapy monotherapy?
Superior dosimetry - palladium 103 Faster half-life decay Lower risk to the patient's family and medical personnel Less of an issue with subsequent urologic procedures such as TURP
What dose-fractionation would you use for cutaneous head and neck squamous cell carcinoma status post resection and skin grafting?
I use the same fractionation schedule that I would use otherwise. Split thickness grafts tolerate radiation poorly, particularly on the scalp. Free flaps are preferred. 60 Gy/30 Fx for negative margins, 66/33 for positive margins, and 70/35 for gross disease.
Would you consider radiation omission in an elderly patient with a 2 mm focus of invasive ductal carcinoma in a background of high-grade DCIS?
I think there is a role in shared decision-making here. Based on the data we have, there is no survival difference with the addition of RT in this situation. Radiation will improve local control. When it was a choice of 5 weeks for that benefit, many chose to omit. With 5 fx, it's a different discus...