Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider chemoradiation to the primary in a patient with resectable pancreatic cancer s/p neoadjuvant chemotherapy found to have single liver metastasis on re-staging?
Typically it is been hard for me to reach a consensus to give radiation for oligometastatic pancreatic cancer in these situations. We have seen some 1-2 patients per year with pancreatic cancer with primary controlled die from liver failure from the liver metastases in my career. So I think that aft...
Would you offer a patient with pT4 renal urothelial cancer adjuvant RT for a positive margin if re-excision is not possible?
Adjuvant radiation therapy for upper tract urothelial cell carcinoma (UTUC) has historically been performed, but is currently not recommended by most cooperative guideline groups (NCCN, European Association of Urology,...). Due to the relative scarcity of this disease, there is no randomized data. L...
How do you approach palliative treatment of a metastasis to the skull with involvement of the overlying skin?
I'm assuming as the question is asking about the role of SRS/FSRT that this is a single or focal skull/bone metastasis involving the skin. Generally if there is tumor involving the skin, whether this is the skull or not, I'd favor a fractionated approach. I would be a bit uncomfortable with SRS as I...
Do you provide prophylactic radiotherapy for heterotopic ossification in young patients?
All the patients I have treated have been healthy males in their 20's who were involved in a motor vehicle accident or engaging in high risk sports referred to me by orthopedic trauma surgeons. These patients are notorious for noncompliance and the opportunity to prevent debilitating HO will be duri...
What dose-fractionation do you use for recurrent SCC (face) that was previously multiply resected and radiated, but has a persistently positive margin after re-resection?
Either 64 Gy at 2 Gy per QD fraction or 64.8 Gy at 1.2 Gy bid. I would electively treat treat the nodes if not previously irradiated. If nodes were previously irradiated, I would not.
For a patient with terminal ileal Crohns disease who requires chemoRT for distal rectal cancer, can mercaptopurine (6MP) be continued during that phase of treatment?
6MP is an antimetabolite that was not developed as a radiosensitizer. So at the right dose it is probably a selective radiosensitizer similar to 5FU. There are no data reported with radiation and 6MP, so this statement is just deductive reasoning. The worst that can happen is an enhancement of acute...
In a patient with distal esophageal cancer with a single non-regional neck lymph node, would you offer chemoradiation therapy or surgery to the primary site if the lymph node has a complete radiographic response after chemotherapy?
If the patient continued to have dysphagia or disease in the esophagus, that would push me to do consolidative chemoradiation. If they are enjoying a good quality of life and no swallowing symptoms and no evidence of disease, I don't believe there is enough data to uniformly recommend chemoradiation...
What small bowel constraint do you use when planning standard/moderately hypofx EBRT for prostate cancer?
For conventional fxn (1.8 Gy) Max dose 52 Gy per RTOG Prostate Consensus Group (PMID:18947938) Personally, use 50 Gy V45 <195 cc per QUANTEC Personally, push lower to <135 cc For moderate hypofxn (2.5 Gy) V40 <1% per Duke constraints (PMID:28244406) To the best of my knowledge, CHHip (60 Gy/...
What dose constraints, if any, do you use for the thyroid gland when treating with regional nodal irradiation for breast cancer?
I have not used any constraints for thyroid for RNI but based on the volume, dose is confined to ipsilateral lobe of thyroid.
How do you approach post operative radiation therapy to someone with head and neck cancer who has high risk of local recurrence who also has scleroderma?
While the risk of morphea (skin and subcutaneous damage ) after radiotherapy to breast ca is well documented, there are very few data about the risk in HNC. Searching Pubmed for: scleroderma, radiotherapy, and head neck, I get only 2 references, one of which is a case report of a severe late toxicit...