Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage cavernous sinus meningiomas?
Radiotherapy or radiosurgery depending on optic nerve dose
How do you approach patients with squamous cell carcinoma of anal canal with ano-vaginal fistula?
Try diversion colostomy, treat and see if it heals
How do you prevent/treat nasal synechiae after radiation for SCC of nasal vestibule?
Vaseline Q tips and nasal douche during and after RT. Bring in weekly after RT, if necessary, to lyse synechiae with Vaseline Q tips
What is your surveillance imaging schedule after whole brain radiotherapy for brain metastases?
I would integrate any follow up schedule within the patient’s plan of care. If you don’t have a plan in the setting of asymptomatic progression within the brain, then why get the MRI? Most patients receiving WBRT are not great SRS or SRT candidates, but if progression means the patient could receive...
How important is a severely diminished diffusion capacity in determining whether to offer a lung cancer patient radiotherapy?
Conventionally, Pulmonary function tests (PFTs) are considered essential before considering thoracic surgery and by extension this rule has applied to definitive radiation. This is because baseline pulmonary function (PF) can predict the risk of pulmonary complications after thoracotomy, and patient...
Do you recommend elective mediastinal nodal irradiation for an inoperable NSCLC patient with N1 disease who is unable to undergo mediastinal staging?
I think that for N1 patients, the risk of developing mediastinal nodal recurrence is high and it is possible that irradiating the mediastinum would reduce this risk, but I don’t think that there are any good studies that sufficiently address this. The patterns of recurrence studies below have grea...
Do you recommend matchline shifts when treating abutting photon and electron fields when treating the chestwall?
There are various way to do it We match photon and electron at skin with no planned overlap. We feather twice during the course with 5 mm shift on either site to spread hot and cold spot. Without shifts there is increased reaction at the match line with increased fibrosis
How do you decide between enrolling an oligometastatic NSCLC patient on LU-002 versus treating them with SBRT off trial?
On behalf of @Dr. First Last, MD, PhD and @Dr. First Last, MDThis question is very important and goes towards the question of equipoise from the perspective of the physician and patient for enrollment on NRG-LU002, accounting for recent data from Gomez et al and Palma et al presented at ASTRO 2018. ...
Would you consider hormonal therapy and no RT in an elderly pt who developed a contralateral early stage, ER+ breast cancer while on Tamoxifen for previous breast cancer?
I agree with @Dr. First Last. I view these cases as more aggressive as the malignancy developed while on hormonal therapy. Of course each case depends on the individual performance status and goals of the patient.
Do you consider additional chemotherapy or durvalumab after definitive concurrent chemo/RT for Stage II NSCLC for patients who are not surgical candidates?
Staging is man-made and somewhat capricious and as stands now essentially completely unmoored from biology in NSCLC. Durvalumab is obviously very moored to biology in NSCLC. There are times we "extrapolate" in oncology; it's tough not to do this in settings where no *specific* data exists but "adjac...