Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your approach to a patient with GE junction or esophageal cancer with oligomestatic disease at presentation?
The patients with oligometastatic disease at presentation are at high risk of polymetastatic progression, so local therapy upfront with suboptimal systemic therapy will not be the preferred approach. We would consider enrolling these patients on studies, and EA2183 is a phase 2 randomized trial test...
What treatment planning challenges do you consider when treating a woman with synchronous bilateral breast cancers?
I think this depends on the scenario and treatment choices: 1. Bilateral early stage cancers- can consider partial breast techniques bilaterally and avoid concerns about overlap 2. Bilateral early stage cancer- whole breast irradiation, I like 1-2 cm between medial tangents to avoid potential double...
What positions and immobilization strategies do you use to minimize breast and heart dose when treating axillary and mediastinal nodes in young women with large breasts who require consolidative radiation (ISRT) for Hodgkins lympoma?
With photon based radiotherapy, I would use a 30 degree slant board if available, deep inspiration breath hold and partial arcs with avoidance parameters for the heart, lungs and breast. The other alternative here is protons.
How soon after ChemoRT for a head and neck cancer can you safely initiate esophageal dilation?
I don’t know of an agreed upon time interval. I would allow for resolution of acute effects, probably 2-3 months.
For head and neck cancer patients who are already edentulous, do you have them leave dentures in for treatment (to avoid changes in jaw position)?
Leave them out if mucositis is likely to develop in the oral cavity
Would you recommend consolidative radiation therapy to an isolated frontal dural MALT lymphoma after complete response to chemotherapy?
I would treat this with ISRT principles with generous dural margins to 24-30 Gy.
How do you manage androgen deprivation in a patient with oligometastatic prostate cancer in which the primary and all known metastatic sites have been treated with curative intent radiation and PSA remains undetectable?
A great question and one that we don't have data for yet! In the absence of data, we can fall back on what we know about prostate cancer and its response to radiation and hormonal therapy, and remember the goals of treatment. Studies in the localized setting combine ADT with RT for 3-26 mo, with len...
What MRI sequences do you utilize for spine SRS treatment planning?
T1 pre contrast scans are helpful for identifying disease that involves the marrow spaces. I would recommend a 3D post contrast T 1 series for identifying extraosseus disease such as epidural or paraspinal extension of disease. Fat suppressed sagittal T2 weighted images can be helpful in assessing t...
Would you recommend re-irradiation to the pelvis for palliation of bone metastases in a patient who previously had prostate brachytherapy?
Great question. So a patient with prior brachy only for his prostate cancer needs palliation for bone met in the pelvic region. I guess my first question would be what type of implant HDR/LDR and at what time did he received the implant? Dose of implant too! What is his clinical state: Age / KPS / c...
How long do you continue surveillance imaging for NSCLC after definitive treatment?
Theoretically, many of these patients would likely have the risk factors to qualify for ongoing low dose CT chest surveillance well after addressing their pulmonary malignancy.https://www.ncbi.nlm.nih.gov/pubmed/21714641