Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach treatment planning for preoperative radiation therapy in gastric cancer?
At MD Anderson, we treat nearly all gastric patients using a neoadjuvant strategy. I've outlined our approach below: For simulation- NPO 3 hours, 4DCT For target delineation- iGTV (from PET, endoscopy report, etc). Mucosal margin expansion = 3cm along the mucosal axis (sup, inf and into the uninvolv...
How would you treat oligoprogressive metastatic GIST to the liver with a single enlarging liver lesion while on imatinib and no other evidence of active disease, where surgery and RFA are not possible?
Please refer to my answer for "Adjuvant RT in GIST" in the Sarcoma section for complete details, but as relative to this question: In the palliative setting, I have radiated a handful of GIST patients who either had painful bone mets or a tumor of the liver with limited other options. If you review ...
What dose-fractionation would you utilize when treating an elderly patient with local-only pancreatic cancer who is not eligible for systemic therapy or surgery?
Elderly means different things to different people. Both PS and age have to be considered. Fatigue in particular is an issue with radiation in the elderly with poor PS. They bounce back very slowly. We now offer a definitive option using an SBRT technique, DIBH, CBCT IGRT, and selective adaptive pl...
Are you using prostate PET imaging for any newly-diagnosed prostate cancers?
December 2021 Update:In 2 years since this original post, a lot has changed. Two different PSMA PET/CT companies have gained FDA approval with broad indications that include the use in newly diagnosed men at risk for harboring metastatic disease. Distribution is well underway with many centers now h...
What would be your recommended adjuvant treatment approach for a completely excised lymphoepithelial carcinoma of the right nose recurrent in a left level IB lymph node, status-post excisional biopsy?
Lymphoepithelial ca refers to undifferentiated ca with lymphocyte infiltrates common in the nasopharynx and salivary glands, and in this patient it likely arose from nasal minor glands. The prognosis of patients with this histology arising in the salivary glands is usually quite good after surgery a...
Would a history of receiving green light laser therapy for BPH change your management of newly diagnosed prostate cancer?
Your intervention will depend on his prostate cancer risk group, if he has a 'huge' prostate still, and bothersome LUTS. It will also depend on if you are in the private sector, or in institutional / academic setting, too. For some, the risk of prior "TURP" like procedures are a contraindication for...
How would you approach neoadjuvant chemoradiation in a patient with a history of Crohn’s disease diagnosed with regional lymph node-positive esophageal adenocarcinoma of the GE junction?
Remember that GEJ was evaluated in MAGIC (and more recently, FLOT4) trial. From FLOT4, about 25% of patients were Siewert I, while another 33% were Siewert II/III.Therefore, if concerns about the severity of Crohn's (and potential RT toxicity) are a significant issue, a reasonable treatment paradigm...
Would you consider RT to LNs in a gr 2-3 adenocarcinoma of the lacrimal gland if there are high risk features?
I always irradiate regional nodes. I treat facial and levels 1 to 3. I have seen failures in facial nodes when only levels 1 to 3 are treated. I have seen level 1 failures when only the facial nodes are treated. These are aggressive cancers. I treat with IMRT.
Would you rather start radiation for Stage III NSCLC in the middle of a chemotherapy cycle or wait for the 2nd cycle if it could not be started on cycle 1 day 1?
While we all strive to provide streamlined multidisciplinary care, it may not always be possible to start at the same time. I usually discuss this with my collaborating radiation oncology physician. I usually like to time the radiation on D1 for logistical reasons. RT treatments for stage 3 disease ...
If you are treating a patient with palliative radiation for hemoptysis do you require chemotherapy to be held?
This is an interesting question. I would like to thank @Dr. First Last for his help with this. In recent years, I have rarely found myself asking colleagues from Medical Oncology to hold chemotherapy for patients who require palliative radiotherapy for hemoptysis. That being said, very few such pati...