Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat high risk prostate cancer in a patient with autonomic bladder dysfunction?
Personally, I have not treated a large number of such patients, but they've generally had this problem due to diabetes or Parkinson's disease. However, it might be prudent to wait for the workup for an etiology before starting radiation therapy. For high risk patients, you're generally considering a...
What do you do when the dose constraints for heart and/or lung do not pass at all in a whole breast treatment planning?
Clinical radiation pneumonitis is rare. For example, a recent study of 191 patients treated with hypofractionation at the University of Pittsburgh found symptomatic pneumonitis in only one patient (Schad et al., PMID 36332799). Another recent study from South Korea of 1,847 patients in which 79% of ...
How do you approach patients with node positive sebaceous cell carcinoma of the eyelid for adjuvant chemotherapy and radiation?
Postop RT. I don’t know of data supporting adjuvant chemo.
For patients undergoing TNT for rectal cancer with planned operative management, what is the optimal sequencing and timing of workup imaging and procedures?
I think the question that is posed does not really make sense as written. One should not be making decisions about management (i.e. TNT) before the staging evaluation is complete. If a patient presents with a newly diagnosed rectal cancer, the first thing to do is to stage to find out whether the pr...
When do you offer SBRT for a small, slowly growing lung lesion?
I caution ALL radiation oncologists from pulling the trigger on a case like this in a vacuum. Why did I use the word "caution"? It's because we recently studied how often a radiation oncology program is comfortable delivering SBRT w/o histopathological confirmation, and the range was between 0 - 61%...
If a patient is noted to have multiple PIRADS-4 and PIRAD-5 lesions of the prostate on MRI, do you offer simultaneous integrated boost via FLAME?
It is a reasonable approach to boost multiple lesions. The FLAME protocol allowed for the treatment of multiple GTVs as long as dose constraints could be maintained. These investigators published a separate paper evaluating the contouring on the trial and reported a maximum of 5 lesions boosted in a...
For women with non-autologous breast reconstruction who require PMRT, is it better to radiate an implant or an expander?
Data suggests higher complications with RT to expander in comparison to implant but that itself is not the only driving factor. I don’t think there is one approach for this as it is a function of many factors including whether the patient would get chemo or not (enough time for expansion and replace...
For patients with solitary plasmacytoma of the ureter undergoing definitive XRT (40-50 Gy), what dose constraint do you use for the ureter?
Well, since this is a solitary plasmocytoma of the ureter, I presume that parts of the GTV encompass the OAR here. I do not think that you can set any meaningful constraint for the ureter, bearing in mind that this is a serial OAR. You can try to avoid hotspots in the ureter, but that's about it.
When do you recommend adjuvant radiotherapy for a resected oncocytic carcinoma of the submandibular gland?
Oncocytic carcinomas are rare, but known salivary gland entities. Likely many were present historically, but since morphologically distinguishing between salivary gland cancers needs pathologic expertise, it is likely that many were "misdiagnosed" as adenocarcinomas or other salivary variants. Few o...
For very large locally advanced head and neck primary malignancies (namely SCCa), how do you decide between adaptive re-planning of a VMAT/IMRT plan during chemo-RT as option instead of induction chemotherapy?
Like Dr. @Dr. First Last nicely noted, there is no survival benefit associated with induction outside of unique circumstances (such as NPC), so we would not routinely use it. Where induction could be helpful over adaptive VMAT/IMRT CRT, in our practice, are in circumstances for locally advanced HPV+...