Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you deal with worsening tinnitus in patients on concurrent chemoradiation with weekly cisplatin for head and neck cancer?
Based on data from three studies at our institution whereby we interchanged Carboplatin when cisplatin toxicity was induced, I would substitute weekly Carboplatin (AUC 2) IV weekly with the remaining RT.
How would you approach a mucinous adenocarcinoma of the anal verge without anal canal involvement, status post excision with positive margins but without the possibility of additional surgery?
The nodal drainage is dependent primarily on the anatomy and not the histology (the histology can determine the likelihood of nodal spread). If the tumor is truly not involving the anal canal one has to assume that this is a cancer originating in the skin and I would manage it as a skin cancer. The ...
How would you manage a patient with Lynch syndrome who is s/p surgery and pelvic RT 20+ years ago for endometrial carcinoma with a new T3N0M0 squamous cell carcinoma of the anus?
I would restrict my radiation fields to the anal tumor only + margin (plus PET+scan volume) and to the inguinal nodes
How would you approach a small mucinous adenocarcinoma of the anal verge (without anal canal involvement) with positive margins after resection?
If resection is not feasible to get negative margins without an APR then I would favor treating with concurrent chemo (xeloda) with RT to a dose in mods 50s to area of positive margin.
How do you counsel patients on the neurocognitive effects of whole brain radiation therapy?
This answer was co-authored with @Dr. First LastThank you for the opportunity to address this important and increasingly complex question. Part of the complexity inherent to this question revolves around the rapidly evolving advances that our field has made in delivering safer brain metastasis treat...
Would you offer modest hypofractionation (e.g. 70 Gy/28 fractions) to a patient with intermediate risk prostate cancer and celiac disease?
Celiac disease is primary small bowel disease. RT effect on rectum would not be exaggerated from the disease.
Should anal cancer patients undergoing definitive chemoradiation be put on a treatment break for neutropenic status?
Thankfully, this a rare event. I would not recommend a break for this reason alone. As correctly stated, IMRT has reduced the skin toxicity, making any skin infection more manageable. Chemo will be held and radiation can continue with the patient on neutropenic precautions.
Would you consider chemoradiation to the primary in a patient with resectable pancreatic cancer s/p neoadjuvant chemotherapy found to have single liver metastasis on re-staging?
Typically it is been hard for me to reach a consensus to give radiation for oligometastatic pancreatic cancer in these situations. We have seen some 1-2 patients per year with pancreatic cancer with primary controlled die from liver failure from the liver metastases in my career. So I think that aft...
Would you offer a patient with pT4 renal urothelial cancer adjuvant RT for a positive margin if re-excision is not possible?
Adjuvant radiation therapy for upper tract urothelial cell carcinoma (UTUC) has historically been performed, but is currently not recommended by most cooperative guideline groups (NCCN, European Association of Urology,...). Due to the relative scarcity of this disease, there is no randomized data. L...
How do you approach palliative treatment of a metastasis to the skull with involvement of the overlying skin?
I'm assuming as the question is asking about the role of SRS/FSRT that this is a single or focal skull/bone metastasis involving the skin. Generally if there is tumor involving the skin, whether this is the skull or not, I'd favor a fractionated approach. I would be a bit uncomfortable with SRS as I...