Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend patients wait to have a total hip sx after salvage radiation for RP?
No, I would not require a waiting period because of the total hip replacement. I standardly use IMRT and we typically avoid incoming beams through artificial joints anyways because of the attenuation. Thus, more likely to use a static multi-beam plan than VMAT if the patient has an artificial hip. U...
How would you approach a patient with well controlled metastatic lung cancer who develops a new primary P16 positive oropharyngeal squamous cell carcinoma?
Multiple primaries are not uncommon. Given tremendous advances in treatments of advanced lung cancer and consequent improvement in overall survival, it is important to focus on screening, early detection, and curative-intent of other cancers whenever applicable. This seems to be one such situation. ...
Would you offer adjuvant radiotherapy to an elderly patient with T4 SCC of the scalp and positive margins 6 months after Mohs surgery?
I would most certainly offer RT in the presence of a non-healing wound. A wound that has not healed in 6 months is almost never going to heal by itself. First up with a non-healing wound, one must suspect a recurrence – even in absence of confirmed biopsy. There are so many instances I have seen peo...
Would you offer RT alone to an elderly woman with squamous cell carcinoma in-situ of the vulva, distal vagina, and periurethral area?
I have had such a patient; multiply recurrent over a relatively large field such as this case. I gave her RT alone (45-50.4Gy) to central structures with large margin (no nodal treatment) and she was recurrence free for 5 years (last time I saw her).
How do you counsel a young female regarding fertility risks from cranial radiation?
Likely low but I am unaware of data. I defer to those more informed.
Would you offer palliative radiation for painful bone metastases in a patient with scleroderma?
Yes, I have treated a breast cancer patient before who had scleroderma and she really wanted to avoid mastectomy. Maybe I was just lucky, but no major skin reaction. Maybe less than average even. Her disease was not active at the time. For bone met palliation, I would use higher energy like 15X for ...
How do you approach borderline non-regional mediastinum lymph nodes when treating locally advanced esophageal cancer?
I basically consider any nodal disease in the mediastinum from esophageal cancer to be operationally regional disease and would include those areas in the radiation fields if feasible. The comment about the nodes being borderline positive is an ambiguity that cannot be resolved in a forum like this....
How would you treat a previously irradiated localized recurrence of an adenoid cystic carcinoma of the nasopharynx?
Assess resectability. If not suitable for gross total resection, and likely not, protons.
Would you recommend consolidative radiation therapy for advanced stage bulky Hodgkin's lymphoma with a delayed complete response after 6 cycles of A-AVD chemotherapy?
I suppose I have three comments about this question.First, the sensitivity (percentage of true positives) and specificity (percentage of true negatives) are generally higher than the positive predictive value (true positives/all positives) for end-of-treatment PET-CT in lymphoma. In one study, the P...
How would you manage prostate cancer in a patient who received prior chemoradiation followed by an APR for rectal cancer?
Patients who have been treated with chemoradiation followed by an APR for rectal cancer and now have prostate cancer and are not surgical candidates do have definitive treatment options despite the previous treatment. Although HDR brachytherapy is usually a great option for patients who have already...