Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What do you recommend for patients who experience anorexia due to loss of appetite?
"But to eat when you are sick, is to feed your sickness."- Hippocrates A lot of preclinical work (Valter longo, Warburg etc) show he was probably right and the fact that tumors will preferentially have access to gluocse and proteins (ie PET scan-Warburg effect)I would use steroids (dexamethasone or ...
For an unknown primary manifested in a left supraclavicular node, what area would you treat with radiation therapy?
Is it adenocarcinoma or squamous cell carcinoma as suspected primary could be in head and neck region or abdominothoracic region in practice I have treated once for squammous cell cancer and opted to treat ipsilateral involved site only with adjoining level 4 and 5 region.
Does finding a positive surgical margin containing pleomorphic LCIS in a patient with early-stage invasive ductal carcinoma of the breast affect your management in regards to breast conservation therapy?
Based on limited data, we treat PLCIS with the same principal as DCIS and aim for a negative margin and offer adjuvant RT. PLCIS presents with microcalcs like DCIS and in the pre e-cadherin staining era, they were called DCIS and included in the old NSABP study as DCIS.
What dose is required to gross disease in the definitive treatment of vulvar cancer?
As with all gynecologic carcinomas, the optimal dose is at least to some extent dependent on the volume of disease. However, our experience suggests that a minimum of 60 Gy should always be given for gross diasease, even when concurrent chemotherapy is being given. That said, for gross disease that ...
Is hypofractionation ever appropriate in women with early stage breast cancer and latent lupus who have never experienced skin symptoms in their lifetime?
Short answer: Yes. I do offer HFRT to such patients. No. I would not advise a "wait-and-see" approach. Long answer: There are actually two categories of considerations here: First, are you comfortable treating patients with autoimmune/collagen vascular disease (CVD)? If so, are you a "lumper" or a ...
What technique, total dose, and fractionation do you use for DCIS following lumpectomy with <2 mm negative margins which are not re-excised?
I offer these patients either hypofractionated WBI (40/15, FAST, FAST-Forward). Consider boost based on margin and other factors.Do consider these patients (DCIS, ER+, 0-2 mm margin) for partial breast as well.
What are the advantages and disadvantages of concomitant versus sequential boost for treating cancers of the head and neck with IMRT?
Concomitant boost IMRT requires just one, while sequential requires two plans (disregarding the possible need for adaptive re-planning, which would be the same in both). BED2 doses to the targets and to specified organs are expected to be similar, however, the doses to the non-defined tissues are hi...
How do you advise patients on the risk for permanent alopecia following RT to the scalp?
If you are treating the skin in a certain area to definitive dose with RT for a skin primary, the patient is almost certain to have a patch of alopecia in the area of treatment. Regarding dose constraints, one older study by Lawenda and colleagues looked at 26 patients treated for CNS primaries and ...
What dose do you recommend for salvage radiotherapy after biochemical recurrence in prostate cancer?
We normally give dose of 66.6 Gy which should be sufficient for microscopic disease. In patients where there is imaging suggesting recurrence or the pre-RT PSA is high then we consider going to 70 Gy for a high volume of disease while taking normal tissue dose into account.There is data for dose esc...
How do you deal with wounds in or around the radiation fields?
Agree with @Dr. First Last completely. As another example, a slowly healing drain or mastectomy wound that remains open during chemotherapy will often close during radiation, despite being within field. I monitor and continue standard wound care, but do not change my treatment fields.