Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When is it safe for a rectal biopsy in a patient with prior prostate radiation?
A biopsy of rectal tissue that has been radiated will have a higher risk of developing non-healing wounds and ulcers. Part of the reason that biopsies are discouraged as well as radiation proctitis is a clinical diagnosis and that biopsies of proctitis are certainly not needed to confirm this. Recta...
How do you proceed with radiation planning for preliminary suspected high grade gliomas after surgery when there is a delay in final molecular diagnosis?
While traditionally, for glioblastoma, we start post-operative radiation therapy within 4 weeks of surgery, recent reports (for example, from Israel) have shown better survival if radiation is started at 6 weeks, which should be sufficient time for molecular studies. If for whatever reason radiation...
What is the significance of LVSI in determining post-op management for oropharyngeal cancer?
It doesn’t change my management.
How do you approach contouring of the ITV for lung SBRT?
For tumors sitting in the middle of the lung and not near any other moving structures with similar Hounsfield units like mediastinum, larger vessels, chest wall, or diaphragm, then maximum intensity projection is a good place to start (verified with 4D video afterwards). If there is contact with oth...
For esophageal adenocarcinoma with extensive associated Barrett's, would you extend your CTV coverage beyond the usual expansions to cover the areas of known Barrett's?
The standard GTV to CTV expansions may include much of the Barrett's, but I would not deliberately target the Barrett's disease, whether treating with neoadjuvant or definitive intent. Chemoradiation is not a proven therapy for Barrett's disease, but treating a larger field will expose more heart an...
How would you manage radiation cystitis in a vulvar cancer patient still receiving EBRT with known history of cystocele and who is otherwise hemodynamically stable?
For me, this is a very confusing question. First, I am not sure what is meant by "radiation cystitis." The question seems to imply that the patient is having hematuria as a component of the radiation cystitis diagnosis. In my long career, I have never seen a patient have noticeable hematuria during ...
In patients with perianal squamous cell carcinoma extending to the vulva, would you cover the entire vulva or would generous margins on the gross disease suffice?
I would generally favor treating with generous margins as opposed to intentionally covering the entire vulva. However, for patients who have a prior history of vulvar lichen sclerosis or vulvar intraepithelial neoplasia where the risk of developing vulvar cancer is higher, I would consider covering ...
For path CR after neoadjuvant chemotherapy in breast cancer with sentinel node (2-3 nodes) negative but >4 nodes positive on initial PET, do you boost the nodes not assessed by sentinel node?
I have boosted the epicenter of these undissected nodes if can identify on CT sim for planning. For CR or pCR in other nodes usually use 56 to 60 Gy and if non pCR or nodes are still enlarged (like IM or s\c) to 60 to 66 Gy.
Do you have experience using photobiomodulation (Low Level Laser Therapy) to prevent and/or treat patients with oral mucositis or other side effects from chemo and radiation?
Taylor et al., PMID 36474663 Is anyone using this routinely as per the cited article?
In a patient with very high risk prostate cancer opting for prostatectomy, when, if ever, do you recommend neoadjuvant ADT?
I generally do not offer ADT with or without a potent ARSI prior to RP even in high risk disease. While small single arm studies have shown that a few such men can achieve a pathologic CR and that path CR/MRD is associated with better outcomes after RP, for most patients, this approach has no clear ...