Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider PMRT in a patient with N0(i+) luminal A disease?
ITC upfront at this point would not sway decision for PMRT unless it is ITC after neoadjuvant systemic therapy
What dose-fractionation would you utilize to treat a multiply recurrent high-grade urothelial carcinoma of the bladder in a patient who is not a surgical nor chemotherapy candidate?
55 Gy in 20 fractions over a 4-week period like MRC
What is your preferred approach for stage III NSCLC with single station N2 disease amenable to lobectomy?
The question of how to handle operable IIIA patients with limited N2 disease has always been controversial, and the new PACIFIC data just makes it more complicated.At some level, it becomes a duel of unplanned subset analysis and a bit of apples to oranges, which is always to be taken with a grain o...
Do you routinely treat the anterior oblique breast suprclav field with 6MV photons or do you use a higher dose, such as 10+ MV?
In the era of 3D planning to cover axilla and s/c area in breast cancer use of high or mixed energy to cover nodes is very common as they are deeper than what can be covered with 6MV without exceeding hot spots size and volume
What anesthetic spray do you use (if any) for numbing the nasal passages when performing nasolaryngoscopy?
I prefer a combination of an anesthetic mixed with a vasoconstrictor. For the anesthetic component, lidocaine with a potency of 2% or higher will suffice. Phenylephrine or oxymetazoline are the typically available drugs for opening the nasal passages. These can be compounded in a solution by the pha...
How do you manage metal dental fillings/prosthetics and hot spot concerns for head/neck radiation?
We use a devise we call "teeth guard", made of polyvinyl siloxane putty described in an article by Ben David M et al. It has a thickness of about 5 mm, which is the typical range of the secondary electrons scattered off metal in the teeth, to reduce hot spots in the gums and tongue. The device and i...
Do you perform a bone health assessment in men who will be receiving short term androgen deprivation for localized prostate cancer?
I do not order bone densitometry on patients I am treating with short term (<= 6 months) of AD, unless they have a risk factor like long-term glucocorticoid use or prior fracture. For patients I am treating with long term >=18 months I perform a baseline bone densitometry. If that is normal-mild ost...
Is there a role for treating actinic keratosis with superficial radiation therapy to widespread areas on scalp?
No.
Would you consider treating the regional nodes in addition to the breast in a patient with skin involvement (pT4b) after a lumpectomy with negative margins/nodes who refuses chemotherapy?
I can't say that this is a commonly encountered scenario. It's tough to imagine the T4 patients that's a good upfront BCT candidate. In my opinion, it is very reasonable to consider RNI in a high risk node negative patient. High risk N0 patients were included in MA.20 and EORTC 22922 and derived sim...
Would you recommend PMRT in a patient with a microinvasive component but a large DCIS component who had a mastectomy with negative margins?
Patients with DCIS treated with mastectomy and negative margins wouldn't get PMRT, so this patient wouldn't either. Essentially, they have an extensive intraductal component, and EIC with negative margins is not a risk for recurrence, thus PMRT would not be warranted.