Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you take any special precautions when radiating the mediastinum of a patient with moderate or severe aortic valve stenosis?
Yes, but this is challenging to quantify. For patients with lung cancer, I generally try to minimize dose to the heart (particularly the left ventricle and coronary arteries) when possible. With aortic stenosis, the left ventricle is particularly “strained”, so one might be particularly-diligent abo...
For patients with breast cancer who are otherwise excellent candidates for omitting radiation based on their age and pathology; does a strong family history of breast or ovarian cancer influence your recommendation?
If gene testing is negative, then it would be fine with AI alone, if the patient is otherwise suitable.
How would you treat a stage IE diffuse large B-cell lymphoma of the adrenal gland in an elderly patient who is not a candidate for systemic therapy?
This is an extremely tough situation if the patient cannot get systemic therapy. These tend to be non-GCB subtype with a generally poor prognosis even with R-CHOP based chemotherapy regimen with high rates of systemic and CNS relapses. Typically, I would recommend R-da-EPOCH, CNS directed chemothera...
When would you consider radiation for a Sertoli-Leydig tumor of the ovary with a bulky mass and peritoneal metastases after surgery and BEP chemotherapy?
I would not use whole abdominal RT, and I probably would not use RT at all. If there is a focal problem, such as the large pelvic mass, that is symptomatic, using RT with palliative intent is reasonable. Dose and fractionation would be dependent on a number of factors. For example, it is likely that...
How do you approach G-CSF use when offering neoadjuvant chemoRT for lower extremity soft-tissue sarcoma?
We don't use concurrent chemo and XRT so it is not an issue for us. I suppose the detrimental effect of XRT on cycling progenitors would depend on the field that is being irradiated. Typical extremity STS may not pose a big risk, but pelvis would.
What would you recommend for a patient with bilateral conjunctival MALT (without systemic disease)?
While technically this patient is stage IVAE (>1 extranodal site is categorized as stage IV), these patients do as well as those with unilateral conjunctival MALT NHL. Bilaterality is not unusual in this disease. This is a situation where definitive treatment (24 Gy in 12) is appropriate for stage I...
Would you consider elective nodal irradiation when treating a solitary mediastinal node recurrence after chemo RT for non- small cell adenocarcinoma?
Rarely do I consider elective nodal irradiation after solitary mediastinal recurrence, especially after previous chemoRT. The morbidity of treating large volumes after previous chemoRT remains significant. After mediastinal relapse, patients still are at the highest risk for distant failure. Therefo...
Given the final results of GOG258, what regimen do you recommend use to treat Stage III endometrial cancer?
Full dose chemotherapy is important in stage III+ patients to prevent risk of distant failure. However, patients in GOG 258 who received chemotherapy alone had an unacceptably high risk of developing locoregional recurrence (27% 5-year incidence combining vaginal + pelvic/para-aortic). Despite conc...
How do you minimize urethral dose when doing LDR prostate seed brachytherapy with small glands (<20 cc)?
These cases can be challenging, especially when you approach the 10 to 15cc range. I’ve approached them using back to back sources in the peripheral needles, and loading the central needles in a manner to minimize the 150 isodose line overlap with the urethra. One should pay special attention at the...
How do you decide which local consolidative therapy to offer for a single lung metastasis in a patient with metastatic colorectal cancer?
SBRT, then more chemotherapy.