Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage moist desquamation when treating breast cancer?
In my experience treating patients with breast cancer, those undergoing postmastectomy radiation and patients with surgically unresectable gross chest wall disease who require use of bolus, are most likely to develop moist desquamation. I agree that for patients undergoing adjuvant postmastectomy ra...
Do you routinely perform an axillary ultrasound in women with newly diagnosed breast cancer without palpable axillary nodes?
The practice has changed a bit with Z11 and AMAROS. For all invasive cancer we do perform sonogram but ifthe nodes are not palpable but only suspicious on ultrasound we don't routinely perform a percutaneus bx. The idea is these patients are still suitable for SLNB and were included in Z11. SLNB wou...
Do you offer SRS to patients with SCLC who have intracranial relapses after prior WBRT?
I do. We wrote up a couple of series on our experience with this a few years back using both GK and linac based systems. https://www.ncbi.nlm.nih.gov/pubmed/23174724https://www.ncbi.nlm.nih.gov/pubmed/21345622
What is your treatment approach for patients with an IDH wild-type, low-grade glioma?
Our neuro-oncology group has begun using concurrent and adjuvant TMZ for patients with IDH wildtype. Our radonc group supports doses of 54 to 60Gy, favoring use of 60Gy on institutional protocol in order to assess the long-term outcomes.
How do you interpret the results of the ACT II trial in terms of the choice between cisplatin and mitomycin in the treatment of anal cancers?
As you know, the ACT II conclusion was that a 5-FU/cisplatin regimen did not improve outcomes and had similar toxicities (less hematologic toxicities) when compared to the standard of care 5-FU/MMC. The RTOG 9811 trial demonstrated worse DFS/OS with induction followed by concurrent 5-FU/cisplatin. B...
Do you routinely re-image all craniopharyngioma patients during radiotherapy?
Yes, typically weekly. Ideally with MRI. HASTE MRI is often sufficient. If the cyst wall has enough calcifications and MRI authorization is a challenge, I will sometimes substitute a CT head (often as a re-sim using the treatment mask).
Which pathologic features do you use to determine VCB vs pelvic RT in Stage IA/IB endometrial patients in the era of Sentinal Lymph node Biopsy?
The decision for adjuvant treatment type for us is based on similar pathological features for node negative endometrial cancer whether node negativity is based on SNL or dissection or sampling Recent randomsied study shows 99% negative predictive value in patients in whom sentinel node is identified...
How do you factor environmental or occupational radiation exposure in counseling or planning for radiation therapy?
I don't think I would counsel not to receive XRT, only that there *may* be increased risks (but the data is conflicting). Quoting Hall, "In the past 50 years, there have been a number of accidents in which small numbers of persons employed in the nuclear program were exposed to total body or partial...
In the era of MRI and other advanced imaging, do you still routinely perform a digital rectal exam on every prostate cancer patient?
Having started my career in the era when the latest in advanced imaging was a first generation CT scan, I still perform DRE on every patient at consultation (unless they refuse). There are several reasons for this approach. First, the information you get from DRE is needed for staging purposes, whic...
What is your approach to managing patients with medically inoperable early stage endometrial adenocarcinoma who also cannot tolerate intracavitary brachytherapy (Rotte-Y, etc) as boost?
The curative-intent treatment of medically inoperable patients can be clinically challenging. Treatment is best individualized, taking into account their comorbidities, severity of disease, and other factors. Inoperability (unsuitable for hysterectomy) is largely due to serious medical comorbiditi...