Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you approach definitive prostate radiation in a patient with evidence of seminal vesicle invasion on MRI, but with adjacent small bowel?
This is a situation where I find an HDR boost can be very advantageous. In most patients I have found that the catheters can easily be placed into at least the first 3 cm of the seminal vesicles, often further. The advantage of HDR over LDR is two fold in this scenario. First, one can manipulate the...
How do you approach the treatment of patients with unresectable paransasal sinus cancers in close proximity to the critical structures of the base of skull?
These (SCC of the BOS/sinonasal) are rare, complex and generally have poor outcomes (low 2 digit survival %). Optic nerve/chiasm, pituitary and cochlear organs are at risk and must be carefully considered. Careful review of imaging with the radiologists (MRI and CT) is recommended. Avoid more than 1...
How long after definitive treatment is it reasonable to consider reconstruction for a woman with inflammatory breast cancer?
I don’t think it is an absolute contraindictation to immediate reconstruction. It is driven by patients desire, her expectations of cosmetric outcomes with RT and type of reconstruction feasible for her
How would you treat esthesioneuroblastoma resected with focal microscopically positive margins in difficult to resect skull base regions?
Yes, it is often difficult to get negative microscopic margins in the anterior skull base in spite of combined ENT and neurosurgery approach. I would be comfortable at this stage to go ahead with adjuvant treatment. The dose of radiation in these situations with microscopic margins would be 70 Gy in...
Do you have any recommended techniques or tips for palliative radiation to a digit (e.g. thumb)?
In my experience, I find Electrons very useful for palliating pain inafflicted digits of the fingers. Because I have lost a few fingernails in my day as well, losing one is NOT a major component of my planning emphasis because they, fingernails,do come back if the patient lives long enough. Most pat...
How would you manage a patient with synchronous locally advanced H&N (p16+) and locally advanced rectal adenocarcinoma?
This is mostly a question of addition of chemotherapy (5FU with Cisplatin) and the timing of radiation therapy to the primaries. The dose of 5U if added for the H&N is not going to be of much effect for the rectal cancer since that would require a weekly 5-day PVI of 5FU. I actually contacted our me...
What is your preferred dose-fractionation regimen for cT1-T2N0 oropharynx treated with radiation alone?
The results from RTOG 0022 showed very high local control and low salivary toxicity with moderately accelerated hypofractionation SIB. They gave 2.2 Gy x 30 fractions (66 Gy) to gross disease, and 1.8 Gy (54 Gy) to lower risk areas and achieved <10% LF at 2 years. 7 patients failed, but 2 of them ha...
Would you electively cover any nerves for adenoid cystic carcinoma of the tonsil with positive PNI on pathology?
Absolutely YES. With positive PNI, I don't think it's just "elective", it should probably be a "must". With the capability to do precision-oriented irradiation technique via IMRT/SRT nowadays, I think target volume coverage along a major branch of a relevant cranial nerve is relatively achievable wh...
How would you treat a high grade sarcoma of the breast?
First, primary breast sarcomas are rare and heterogeneous, and no clear universal guidelines exist and these patients should be managed on a case-by-case basis, preferably at a tertiary care center with expertise in sarcoma. Histologies include angiosarcoma (primary or radiation-associated) and undi...
How do you approach a patient with prostatic urethral lift (UroLift) seeking definitive radiation for prostate cancer?
I've not yet seen a patient with a UroLift device in place. Apparently, from the company website, the device is H-shaped and the vertical parts are on either side of a prostate lobe and connected by a suture-like strand. The vertical parts compress the prostate lobe and are placed on either side of ...