Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you take any precautions in planning PMRT for patients who had taxane-induced pneumonitis?
The data regarding increase risk of radiation pneumonitis with Taxoil chemotherapy was more of a timing than lung volume issue. This risk was extremely high (>15%) when RT was given concomitant with radiation in the early days and also when it started close to the last cycle of taxol. We have notice...
What factors other than resection status (R1,2) do you consider when offering adjuvant chemotherapy for patients with thymic carcinoma, and how do you coordinate with post-op radiation?
I do not routinely recommend adjuvant chemotherapy for patients with resected thymic carcinoma as there is no data that this improves outcome. If not an R0 resection, then we recommend post-operative radiation therapy.
How does a sentinel lymph node biopsy versus nodal dissection affect your treatment decision for Stage II endometrial cancer?
For stage II endometrial cancer, pelvic relapses can be at cuff, node and parametria. So if type I hysterectomy is done we favor EBRT unless all factors are favorable and stromal invasion is limited to inner 1/3 rd ( superficial )https://www.ncbi.nlm.nih.gov/pubmed/28866431
What dose would you treat a patient to for a positive deep skeletal muscle margin after mastectomy who is not a candidate for re-resection?
I would offer PMRT and boost the area of positive margin to 60-66 Gy based on pre op imaging and extent of positivity seen on pathology
Does HIV/AIDS change your management of locally advanced NSCLC?
Those with negative viral load and CD-4 counts > 500 are just like HIV negative. Non compliant, Low CD4 and fluctuating viral loads at risk for toxicity of treatment. For CD4 < 200, I would not use concurrent therapy. Perhaps sequential. Maybe XRT alone. Many have not used anti-retrovirals consisten...
Does external iliac coverage, such as in a T4 primary, justify IMRT for rectal cancer?
In training, I was taught that IMRT may be justified in rectal cancer with T4 disease, because a greater volume of bowel was treated when the field was extended anteriorly, and that seems to make sense. Overall, more people are using IMRT for rectal cancer patients, but it doesn't seem to coincide w...
Is radiation an appropriate alternative for a patient with multiply recurrent CIN 3 being considered for hysterectomy but unable to be medically optimized for surgery?
No good data but by rationale this is reasonable Brachytherapy alone using 3D image guidance is what I would use 7 to 8 gy x 5 fractions to entire cervix
What is your approach to genetic testing for high risk patients?
At our center, clinical assessment initiated at diagnosis and anybody who meets the NCCN criteria is referred to genetic counsellor
What is the complication profile of subpectoral versus sublgandular implants after PMRT?
The numbers are all over the places because of most being retrospective dataThis is very nice review with compilation of both retrospective and prospective data
Would you consider observation instead of a Whipple in a borderline resectable pancreatic cancer patient treated with neoadj CRT who has a radiographic CR?
There are always many reasons for not doing a Whipple. While it is the one intervention that increases survival most significantly for this disease, it is still rarely curative in the long term and comes with surgical morbidity. Therefore patients with potentially unresectable disease, or with a bad...