Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Do you contour and constrain the sublingual glands?
Agree with Dr. @Dr. First Last. I would like to comment that while level I is a target in OC cancer, the submandibular gland is not. Embryonically, the parotid glands develop before the lymphatic system does, such that lymph vessels enter it. In contrast, the SMGs develop after the lymphatic system ...
Do you hold mTOR inhibitors during radiation?
MTOR inhibitors may be radiosensitizers but in limited times, I have not held this drug for palliative RT.
Is a FAST regimen reasonable for re-treating a patient with PBI after prior whole breast radiation ten years ago?
May be reasonable but for now, we prefer 40 in 15 PBI using VMAT or multibeam IMRT.
How would the development of pneumonitis from pembrolizumab after treatment as per Keynote 522 alter your PMRT recommendations?
If recovered completely, I would proceed with PMRT.
Do you always obtain PSMA PET as initial staging for high risk and very high risk localized prostate cancer patients?
I do obtain a PSMA PET/CT or PET/MRI in all patients with high risk localized prostate cancer. However, when this is not available due to insurance coverage issues or lack of access to PSMA PET, it is still acceptable to stage with bone scan and CT or MRI. I prefer PSMA PET because it has better per...
When would you consider adjuvant radiation therapy for tenosynovial giant cell tumors of the extremity?
Yes, if it was recurrent or subtotally resected.
When treating with electrons, what is your approach to skin collimation to reduce penumbra next to structures such as the eye?
Skin surface shielding/collimation can be accomplished by a few methods. One is to create an impression of the patient and then conform thin sheets of lead/high density shielding material to this shape with an appropriate aperture for the target. This is time-consuming but preferable for small targe...
What is your approach to rectal cancer staging in patients who cannot undergo an MRI?
Endoscopic ultrasound of the rectum in addition to CT scans with contrast, if any doubt, will do a PET/CT scan.
Are there single fraction regimens for postoperative treatment for keloids?
10 Gy in a single fraction Ragoowansi et al., PMID 12711944