Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does your department manage scheduling surrounding holidays?
The impact of treatment prolongation on local control has been well established for cervical cancer and squamous cell carcinoma of the the head and neck, presumably due to the phenomenon of accelerated repopulation. At University of Minnesota, we make every effort to minimize unplanned treatment bre...
What is appropriate local salvage therapy after prostate brachytherapy failure?
I would not re-irradiate the prostate using EBRT. I would only use HDR brachytherapy. I would give 6Gy x 6 /2 implants based on our published experience. Alternative fractionation is 8Gy x 4 based MSKCC study. There is also data on permanent seed salvage. That is mostly for post EBRT failure. Howeve...
What do you recommend if you find persistent lymphadenopathy during CT simulation for adjuvant head/neck radiation therapy?
Assuming the simulation was performed in a timely manner (within 3-5 weeks post op), in the majority of cases this would be considered an early recurrence despite an adequate neck dissection (min 15-20 nodes), and requires intensified salvage (rather than adjuvant) treatment. Addition of chemo/syste...
In what situations, if any, do you offer postoperative radiation or chemoradiation for patients with squamous cell carcinoma of the esophagus?
A very pertinent question, especially as the pendulum has swung towards treating esophageal cancers with neoadjuvant therapy - indeed, it has been quite a few years since I have treated an esophageal cancer case adjuvantly. The way I think about it, is that what is good for neoadjuvant therapy is go...
What do you consider a radiation oncology emergency?
I like this question. There are the classic ones that we've all treated in residency and since then: 1. Spinal Cord Compression (Obviously). 2. Intractable bleeding, particularly in GYN cases, though packing should be applied as well. 3. Intractable pain with a clear cause by tumor structure. 4. Rap...
Is there evidence that radiation therapy can cause a flare in cancer antigens or other biomarkers?
I have noticed with limited experience and elevation of CA 125 during RT for localized recurrent ovarian cancer which has settled down to normal after completion of RT. Could be because of release of antigen caused by tumor breakdown.
How do you manage intractable hiccups from radiation?
Hiccups can be extremely vexing for patients while they receive radiotherapy. I gauge my need for medical intervention based on their history of hiccup frequency and pattern through the day (e.g., night-time hiccups only), as well as the kind of other interventions the patient may have attempted. I ...
Is TTF treatment an appropriate option for recurrent GBM?
Absolutely. This was the first FDA-approved indication for Optune. Although it was approved in 2011, one could say that it never really "caught on." I personally did not start using it or recommending it until the second FDA approved indication (for upfront first-line treatment) appeared around 2015...
For retroperitoneal sarcomas, do you consider neoadjuvantly boosting the "posterior rind" or area at high risk of positive margin?
I routinely recommend preoperative IMRT to treat retroperitoneal sarcoma, although we have no level 1 evidence to support this approach. Currently the EORTC is conducting a phase III trial to investigate a role preoperative radiation (3DCRT or IMRT) in treatment of retroperitoneal sarcoma (primary e...
What dose/fractionation do you use when treating SCC of the vagina with vaginal cylinder brachytherapy after EBRT?
Typically, we give 5Gy x 3Fx prescribed to a depth of 5mm. However, this may be more than necessary. See this discussion: https://www.themednet.org/question/270