Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How soon after ChemoRT for a head and neck cancer can you safely initiate esophageal dilation?
Interesting, I think that we saw fewer before gastrostomy tubes and whole neck IMRT
For head and neck cancer patients who are already edentulous, do you have them leave dentures in for treatment (to avoid changes in jaw position)?
Leave them out if mucositis is likely to develop in the oral cavity
Would you recommend consolidative radiation therapy to an isolated frontal dural MALT lymphoma after complete response to chemotherapy?
I would treat this with ISRT principles with generous dural margins to 24-30 Gy.
How do you manage androgen deprivation in a patient with oligometastatic prostate cancer in which the primary and all known metastatic sites have been treated with curative intent radiation and PSA remains undetectable?
A great question and one that we don't have data for yet! In the absence of data, we can fall back on what we know about prostate cancer and its response to radiation and hormonal therapy, and remember the goals of treatment. Studies in the localized setting combine ADT with RT for 3-26 mo, with len...
What MRI sequences do you utilize for spine SRS treatment planning?
T1 pre contrast scans are helpful for identifying disease that involves the marrow spaces. I would recommend a 3D post contrast T 1 series for identifying extraosseus disease such as epidural or paraspinal extension of disease. Fat suppressed sagittal T2 weighted images can be helpful in assessing t...
Would you recommend re-irradiation to the pelvis for palliation of bone metastases in a patient who previously had prostate brachytherapy?
Great question. So a patient with prior brachy only for his prostate cancer needs palliation for bone met in the pelvic region. I guess my first question would be what type of implant HDR/LDR and at what time did he received the implant? Dose of implant too! What is his clinical state: Age / KPS / c...
How long do you continue surveillance imaging for NSCLC after definitive treatment?
Theoretically, many of these patients would likely have the risk factors to qualify for ongoing low dose CT chest surveillance well after addressing their pulmonary malignancy.https://www.ncbi.nlm.nih.gov/pubmed/21714641
What dose constraints do you use for the pulmonary vein, pulmonary artery, and superior vena cava for thoracic reirradiation after prior conventional fractionation to a central lung tumor?
In my opinion, the best paper to address this is from Stanford University. The authors describe normal tissue toxicity after thoracic reirradiation. Various dose fractionation schedules were used for both the 1st and 2nd courses of radiation, with dose converted to conventional fractionation (2 Gy e...
Is it feasible to give pelvic radiotherapy in patients with a congenital, functioning, pelvic kidney?
Agree with @Dr. First Last Pelvic kidney is not necessarily a contraindication to radiation with modern (e.g. IMRT) RT planning Lots of teaching cases and case series For these patients, we first make sure treatment to the pelvis is absolutely necessary. Treatment planning is done with high priority...
How does the presence of active rheumatoid arthritis on rituxan impact your decision to proceed with prostate radiation?
I am always concerned about irradiating a patient with an active chronic inflammatory condition, as these people may be more prone to toxicity, both acute and late. In the case of a patient with both prostate cancer and rheumatoid arthritis, the latter being treated with rituximab, the fact that he ...