Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose constraints do you use for the pulmonary vein, pulmonary artery, and superior vena cava for thoracic reirradiation after prior conventional fractionation to a central lung tumor?
In my opinion, the best paper to address this is from Stanford University. The authors describe normal tissue toxicity after thoracic reirradiation. Various dose fractionation schedules were used for both the 1st and 2nd courses of radiation, with dose converted to conventional fractionation (2 Gy e...
Is it feasible to give pelvic radiotherapy in patients with a congenital, functioning, pelvic kidney?
Agree with @Dr. First Last Pelvic kidney is not necessarily a contraindication to radiation with modern (e.g. IMRT) RT planning Lots of teaching cases and case series For these patients, we first make sure treatment to the pelvis is absolutely necessary. Treatment planning is done with high priority...
How does the presence of active rheumatoid arthritis on rituxan impact your decision to proceed with prostate radiation?
I am always concerned about irradiating a patient with an active chronic inflammatory condition, as these people may be more prone to toxicity, both acute and late. In the case of a patient with both prostate cancer and rheumatoid arthritis, the latter being treated with rituximab, the fact that he ...
How do you deal with worsening tinnitus in patients on concurrent chemoradiation with weekly cisplatin for head and neck cancer?
Based on data from three studies at our institution whereby we interchanged Carboplatin when cisplatin toxicity was induced, I would substitute weekly Carboplatin (AUC 2) IV weekly with the remaining RT.
How would you approach a mucinous adenocarcinoma of the anal verge without anal canal involvement, status post excision with positive margins but without the possibility of additional surgery?
The nodal drainage is dependent primarily on the anatomy and not the histology (the histology can determine the likelihood of nodal spread). If the tumor is truly not involving the anal canal one has to assume that this is a cancer originating in the skin and I would manage it as a skin cancer. The ...
How would you manage a patient with Lynch syndrome who is s/p surgery and pelvic RT 20+ years ago for endometrial carcinoma with a new T3N0M0 squamous cell carcinoma of the anus?
I would restrict my radiation fields to the anal tumor only + margin (plus PET+scan volume) and to the inguinal nodes
How would you approach a small mucinous adenocarcinoma of the anal verge (without anal canal involvement) with positive margins after resection?
If resection is not feasible to get negative margins without an APR then I would favor treating with concurrent chemo (xeloda) with RT to a dose in mods 50s to area of positive margin.
How do you counsel patients on the neurocognitive effects of whole brain radiation therapy?
This answer was co-authored with @Dr. First LastThank you for the opportunity to address this important and increasingly complex question. Part of the complexity inherent to this question revolves around the rapidly evolving advances that our field has made in delivering safer brain metastasis treat...
Would you offer modest hypofractionation (e.g. 70 Gy/28 fractions) to a patient with intermediate risk prostate cancer and celiac disease?
Celiac disease is primary small bowel disease. RT effect on rectum would not be exaggerated from the disease.
Should anal cancer patients undergoing definitive chemoradiation be put on a treatment break for neutropenic status?
Thankfully, this a rare event. I would not recommend a break for this reason alone. As correctly stated, IMRT has reduced the skin toxicity, making any skin infection more manageable. Chemo will be held and radiation can continue with the patient on neutropenic precautions.