Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In a patient with end stage renal disease and chronic oliguria, what strategies do you use to avoid excessive bladder irradiation when treating prostate cancer with external-beam radiotherapy?
If a patient has end-stage renal disease, the first question I would ask is what is the patient's life expectancy? According to several papers I have reviewed, the median life expectancy of a person with ESRD is about 4 years. I therefore would not perform localized therapy in a person with such a l...
What radiation dose, fractionation and volume would you use in an elderly patient with localized extensive anorectal malignant melanoma status post laparoscopic APR?
What a great question! This has come up a couple of times in my clinical practice. For anorectal mucosal melanoma that is completely excised and < 7 mm depth of invasion, I have done surface intra-cavitary brachytherapy with a Capri cylinder. For deeper lesions or LN involvement, I have used photon...
Do you wait a certain time period before initiating palliative or definitive radiation to NSCLC after airway interventions such as rigid bronchoscopy tumor debulking, APC, etc.?
Good question and the data is sparse. It really depends on the reason for the therapeutic bronchoscopy. If the patient has a collapsed lung due to endobronchial obstruction, it is reasonable to wait for lung reexpansion. Delivering radiation to a collapsed lung can commonly reduce the likelihood of ...
Would you offer adjuvant chemoRT to a patient with pancreatic adenocarcinoma who underwent neoadjuvant therapy with FOLFIRINOX and SBRT but had a positive (neck) margin on resection and is now s/p adjuvant chemotherapy?
This is why low dose, small volume SBRT is a flawed neoadjuvant treatment. This is possibly a marginal miss. It rarely happened in the past with conventional pre-op treatment but now it is happening commonly. Many patients are suffering because of it. It is important to assess the margin was in the ...
How do you image when using DIBH with breast treatment?
For patients undergoing DIBH we use standard portal imaging only.
Do you attempt to spare a strip of skin for palliative 8 Gy x 1 fraction radiation treatments?
Great question. Do I attempt to spare some measure of skin during treatment course requiring palliative EBRT at 800cGy x1? Answer: NO. Generally, in my experience over the past few years with using single fractions palliatively, skin sparing is just not an issue, for the most part. Further, as I rec...
How would you manage a patient with a MALT lymphoma (H. Pylori negative) found incidentally in the surgical specimen at the time of sleeve gastrectomy?
MALT lymphoma tends to be a multifocal disease. Furthermore, imaging is often suboptimal in delineating the true extent of disease within many extranodal sites, including the stomach. For these reasons, the entire organ is typically treated during a course of radiation therapy. Historically, radical...
Would you offer radiation therapy for pleural- or peritoneal-based pseudomyxoma peritonei?
There are no published data that clearly support the use of radiation in this disease. In general, the best one could hope to achieve is to slow or arrest the mucin production from the cellular component of the disease. I have tried this with variable success using palliative doses.
How do you manage soft tissue necrosis in a patient who underwent TORS followed by RT?
Close observation Minimize trauma Don’t biopsy unless something very suspicious
What is your preferred workflow when treating AVMs with SRS?
There's more than one way to optimize workflow when treating AVMs with SRS and workflow may depend on the SRS modality. We have a Gamma Knife at our institution, a headframe placement is performed first followed by cerebral angiography, MR angiogram of the head and MRI Brain scan. All images are reg...