Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage an endometrial cancer with no (or minimal) myometrial invasion and only a very small focus of disease in a pelvic node?
Eventhough stage IIIC endometrial cancer is the most common sub-stage among locally advanced patients, patients with node positive disease have routinely been combined with other stages for clinical trial purposes (including high risk early stage disease, stage IV, and recurrent disease). This not o...
When would you consider local ablative therapy (e.g. SBRT, surgery) for patients with oligometastatic non small cell lung cancer on immunotherapy?
Definitely would treat this exactly as I do for EGFR or ALK-targeted therapy. If the patient is doing well, and most sites of disease continue to be controlled but one is progressing I would consider local ablative therapy. That being said, I just had a patient doing well with a CR on ipi-nivo for ...
What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?
The bottom line is there is no magic bullet that works well. I start Glutamine a week before and throughout the duration of the treatment. It seems to delay the onset. I use custom made mouth pieces to reduce dental scatter if possible--that will reduce mucositis I start with over the counter analg...
How would you manage treatment of a cervical cancer in a patient unable to tolerate chemotherapy or an HDR boost due to medical commodities?
The first step is to be absolutely certain that brachytherapy is not feasible. In our experience this is extremely rare. The patient should have a thorough medical evaluation and have their medical conditions optimized as much as possible before the decision is made to withhold these standard elemen...
What treatment would you recommend for a 3 cm basal cell carcinoma of the perianal skin with anal canal involvement?
I would confirm with adequate bx that it is not basosquamoid as then management would be chemo RT like anal cancer If indeed it is rare basal call ca and since Anal canal is involved I would treat with RT alone with conventional fractionation to close to 60 Gy like skin cancer
Would you recommend adjuvant chemoradiation for a resected ampullary adenocarcinoma?
There is no clear cut answer to this question. There is suggestive evidence from retrospective studies that adding radiation therapy to a chemotherapy regimen improves outcomes, but those are retrospective and non-randomized, with all the inherent difficulties in those analyses. The limited randomiz...
What image guidance do you use when treating rectal and anal cancers?
For anal cancer, daily CBCT for the first three fractions to evaluate bladder filling mostly (and to make sure there's not surprise excessive gas in the anus/rectum). After that, KV daily and CBCT weekly. If treating with a vaginal dilator in, I may CBCT more frequently to evaluate its position.
In what situations would you consider treating metastases to the spine with proton SBRT?
For any question I must rely on evidence to answer it. So the first thing is- what is the published data on the use of proton SBRT for spine metastasis (not primary spinal cord tumors)? I am unaware of any outcomes data, and after a quick pubmed search I found zero papers (not even retrospective out...
Do you consider a dose constraint to the phrenic nerve during lung and liver SBRT?
This is a very interesting question for which I can not provide a ready answer since to my knowledge, there are no series or case reports that have specifically identified phrenic nerve injury associated with a course of SBRT. I would suggest that establishing constraints for this nerve would likely...
What LN stations would you advise covering for lung adeno with + LN at level 9 s/p lobectomy + LND?
Data from the Lung Adjuvant Radiotherapy Trial Investigators Group (Lung ART) are forthcoming, as the trial recently completed accrual I think). In the interim, their protocol is quite helpful in determining which nodal stations to include post lung resection, when adjuvant RT is deemed appropriate....