Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you use a chest wall constraint when treating large lung cancers with 8 or 10 fraction SBRT?
There are a few studies that report that the volume receiving 30 Gy correlates to toxicity, and the Kavanaugh paper provides a "rule of thumb" - if 30cc of chest wall receives 30 Gy or more, then there is a 30% risk of severe chest wall toxicity. Dr. Videtic at Cleveland Clinic reports this, as well...
What naming convention do you use when treating multiple brain mets with SRS?
I don't have any special naming convention. I just try to give each metastasis a different name. So if 3 metastases in the L frontal lobe, I might call them L frontal sup, L frontal med, L frontal inf. But this question raises a various serious issue, and that is the confusion that can arise as to w...
Do you offer adjuvant post-prostatectomy radiotherapy to patients with inflammatory bowel disease?
In general, I do not recommend adjuvant radiation for patients with inflammatory bowel disease, even with very high risk features, such as positive nodes. These patients generally have a very long life expectancy, and are at increased risk for long term complications from pelvic radiation. Unfortuna...
What is your preferred treatment for spinal drop metastases from a glioblastoma?
This is a relatively uncommon, but challenging clinical situation, and usually the prognosis is poor. Our approach is as follows: 1. Detailed MR imaging of the spine to ensure that the failure is truly focal, and not multifocal or leptomeningeal: 2. Thorough re-imaging of the brain to ensure that t...
How, if at all, does the presence of hemorrhoidal bleeding affect your radiation recommendations for prostate cancer?
My first quest is to determine what risk group (low/intermediate/high) is the patient in as it relates to the prostate cancer because if it is either of the latter two, ADT will probably be a component of the treatment regime, and this will buy you time to render the afflicted hemorrhoid(s) resolved...
Is there an age cutoff over which you would not recommend definitive radiation for intermediate risk prostate cancer?
In general, I prefer to try to evaluate a patient's physiological age rather than merely use chronological age as an absolute cut off for definitive radiation. Thus, both performance status and co-morbidities factor heavily into my decision whether or not to recommend definitive radiation. In additi...
How do you approach SRS for brain metastases in the presence of cranial hardware?
Cranial plates may be placed that could potentially affect the dosimetry of SRS. Specifically with Gamma Knife, although one can select planning (CC convolution) that could account for the high Z material of the cranial plate, it is felt that the 192 multidirectional beams of radiation would make th...
Is there a role for extended treatment volumes (elective nodal) in the definitive treatment of parameningeal rhabdomyosarcoma in a young adult?
If by "extended treatment volumes" you are asking about cranial or craniospinal radiation therapy, the answer is an emphatic NO. We demonstrated by careful review of patterns of failure that cranial irradiation was unnecessary in PM-RMS (Michalski 2004). The IRS and subsequently the COG have abandon...
Is it safe to irradiate a patient with Cowden syndrome?
I irradiated 1 patient with breast cancer and Cowden syndrome about 25-30 years ago and she tolerated it well without any unusual early or late toxicity
Do you recommend bevacizumab in platinum sensitive recurrences of epithelial ovarian cancer?
Bevacizumab was approved for use in combination with chemotherapy followed by continued bevacizumab maintenance in patients with platinum-sensitive recurrent ovarian cancer in December 2016. This approval was based on the findings of 2 studies, GOG-213 and the OCEANS trial. Both trials demonstrated ...