Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat a radioresistant (e.g. RCC or melanoma) oligometastases in a weight-bearing bone after surgical resection and stabilization?
Let's assume we are dealing with a femoral met. If the surgeon just puts an intramedullary (IM) nail through the tumor (tumor not resected), the whole length of the nail will have to be treated as it carries the tumor cells with it as it goes down through the medullary canal. In this situation, exte...
What treatment volume should be included for a resected glioma with a large hygroma adjacent to the resection cavity?
In general, post-operative hydroma is considered as part of surgical cavity/postoperative change. As a result, it is included in the radiation target volume. The histological grade generally doesn't impact the decision, unless, it is a WHO grade I pilocytic astrocytoma. In such case, we could consid...
Do you offer bladder-sparing approaches as an alternative to cystectomy for surgery-eligible patients with muscle-invasive bladder cancer?
We have a bladder cancer multispecialty clinic at SCCA/UWMC in which we also see patients with localized MIBC and we balance carefully risks vs benefits, rationale, data, details & logistics of options. Overall, cisplatin-based chemotherapy (for fit patients) ->radical cystectomy with PLND, OR maxim...
Is there a role for a salvage lymph node dissection in patients who present with a biochemical failure after prostatectomy?
It's an important question without randomized data to support an answer. Even this question will evolve as we bring on-board more advanced imaging such as Fluciclovine PET/CT, PSMA PET, etc. These scans are continuuing to introduce new challenges as we start to resolve the location of lesions and so...
Which chemotherapy regimen (if any) do you recommend for palliative concurrent chemoradiation for a symptomatic patient with metastatic cervical carcinoma and CKD stage 4 (GFR 15-29)?
For patients who cant get cisplatin because of poor kidney function, we have used taxol at 45-50 mg/m2 weekly ( metabolized through liver) based on phase 2 data. In our experience it is tolerated well.
When do you use IMRT in breast radiotherapy?
We seldom use it. Our limited dosimetric experience shows that even though coverage of regional nodes improves, the V10 and V20 of the lung and the mean heart dose also increase. Thus, the small benefit of improved coverage (EORTC and Canadian data showed small improvement in DFS) has to be weighed ...
Is acute pancreatitis a contraindication to radiotherapy for patients with pancreatic cancer?
No, it is not a contraindication to the use of radiotherapy. Radiotherapy has been used in the very distant past to treat acute pancreatitis. If anything radiotherapy will help reduce the inflammation.
What IGRT strategy do you use when treating intact prostate?
We typically do gold fiduicials at our institution for all intact prostate cases and for all fractionation schemes. Only patients we do not do gold fiducials on are those who decline or those who have poor performance status [or otherwise unable to tolerate the gold marker procedure] - in these case...
What is the most appropriate management for a patient with a primary brain sarcoma?
This is a complicated questions, since brain sarcoma covers a wide spectrum. For patients with gliosarcoma or glioblastoma with sarcoma component, they should be treated as GBM. They are eligible for most trials for GBM. Off protocol, they should receive chemo-RT per Stupp regimen. For other sarcoma...
How to you manage radiation brachial plexopathy in head & neck patients?
I am not aware of any effective therapy for brachial plexopathy. Bevacizumab has been reported to be beneficial in radiation-induced brain and retinal injury but I am not aware of its use in neuropathy. In any case, brachial plexopathy after RT of HN cancer is quite rare. I do not recall any BP case...