Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is a safe time interval from completion of hormones and external beam radiation to TURP in patients who develop refractory obstruction?
Great question. Ordinarily, in my past experience, if a patient had real LUTS >14 AUA score that was not relieved with alpha blockers, and/or had a large median lobe, we would prefer the TURP be done upfront and / or chemical debulking with ADT too. In these instances, we found we had less LUTS then...
How do you approach nodal coverage in PORT for NSCLC with involved station 8?
My recommendation is to review pre-op image and discuss with the surgeon who did the operation. Station 8 is not routinely sampled or dissected for NSCLC. I don't recommend to cover GEJ routinely due to toxicity.
How do you approach a case of nasopharyngeal adenoid cystic carcinoma with neck node unilaeral involvement?
ACCs could spread to the lymph nodes on occasion. This probability increases when they arise from minor salivary glands located in regions rich in lymphatic drainage such as the pharynx. If a patient were to present with node positive disease, I would treat the bilateral neck lymph nodes with an ele...
What factors do you consider when interpreting post treatment PET Deauville scores for patients treated with chemotherapy for classical Hodgkin Lymphoma?
PET-CT interpretation using Deauville Criteria (5 point scale) provides a more objective and descriptive methodology than previous scoring systems. However, there are still numerous limitations and challenges and I suspect refined methods to report PET-CT responses will evolve in the future. I utili...
How would you approach a locally advanced, radioiodine naive papillary thyroid carcinoma not amenable to a non-morbid surgery?
In certain cases there may a be a potential benefit. We have an 87 year old male with significant co-morbidities that prevented him from being a surgical candidate. Stage 4 papillary thyroid cancer with 1.7 cm right thyroid primary, 2.5 cm RML lung mass and 5 cm right cervical neck mass that was ver...
Should special precautions be taken when treating oligometastatic disease in the sacrum or pelvis with SBRT in a patient with a long life expectancy?
There's so much good data now that if you can work it out (insurance, etc) it's worth doing. My suggestion is to do it, but paint within the lines, meaning don't use a dose that's poorly studied and 1) adhere to good quality dose constraints like TG101, and 2) consider the PTV coverage...in that ord...
For localized prostate cancer patients, do you routinely give antiandrogen therapy for patients receiving LHRH agonist therapy?
Although studies have given anti androgen for variable period of 4 weeks to 6 months, we use it only to suppress testosterone flare.
How long would a vulvar cancer s/p definitive chemoradiotherapy, how long should the lesion be followed for regression before initiating biopsy or salvage surgery?
There is no prospective data but our practice is to perform once the acute reactions subside, usually 6-8 weeks after chemo RT.
When do you recommend prone breast radiation?
If the plan is for whole breast radiotherapy without nodal treatment, I treat almost all women prone. The only women that are treated supine are those that have lump cavities that preclude the benefit of a prone plan (positioned posteriorly along chest wall, so tangents cut through lung/heart) or th...
Would you consider prone SBRT (with solid image guidance techniques) if bowel is lying on a target, for instance bowel surrounding an oligometastatic lymph node or next to a kidney tumor?
I have done this, but rarely do. Patient setup uncertainty tends to increase in the prone position, thereby increasing the required PTV margin. This may limit the anatomical benefit of performing treatment in the prone position. However, if it works there can be great value in moving a radiosensitiv...