Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does anticoagulation alter your decision for elective nodal radiation in a prostate cancer patient?
The short answer is no. I have not seen strong evidence that anticoagulants increase the risk of GI toxicity. However, if bleeding develops, it may be more difficult to manage. The source of bleeding is generally in the anterior rectal wall, as it is with patients not on anticoagulants. Thus, I tend...
Does the presence of a BRCA 1/2 mutation affect your recommendation for post-mastectomy RT in patients with pT1-2, N0 disease?
It doesn’t influence RT decision.
How would you treat a metastatic small cell carcinoma of the larynx that is locally progressing on cisplatin/etoposide?
I assume metastatic means distantly metastatic. 30 Gy/10 fx or 20 Gy/5 fx local regional RT if progressing on chemo.
How would you approach an early stage node negative breast cancer s/p BCS with a history of severe chest wall burns?
I would favor APBI to minimize volume treated.
How do you account for previous dose from I-131 when delivering external beam radiation therapy near the thyroid bed?
Since I-131 is selectively taken up by thyroid cancer cells and the range of beta particles emitted is 1-2 mm, there should not be any big concerns of overdosing OARs. https://ehs.stanford.edu/reference/i-131-radionuclide-fact-sheet http://www.docs.csg.ed.ac.uk/Safety/rpu/gn/GN009.pdf.
What plan parameters do you prioritize in 3D conformal breast treatment planning?
For whole breast 3D conformal RT, we contour surgical bed with 1 cm expansion for CTV and 3-5 mm for PTV.Coverage whole breast 95% of volume to 95% of dose we aim for but we accept 90 to 95.PTV (surgical bed) as above, 95% of volume to 100% of dose but accept 95 to 95 also.Volume of breast getting 1...
How would you treat a bone oligometastasis that required surgical fixation for pathologic fracture?
It really boils down to the clinical scenario and the approach of the operation. Any time there is a possibility that the surgical procedure may shove the tumor/ tumor cells into the medullary cavity, one will need to include the whole surgical hardware in the RT field. A cone-down or simultaneous b...
Would you consider SBRT for an intraocular/choroidal metastasis?
For solitary choroidal metastasis, I would recommend eye plaque brachytherapy using I-125 seeds with a dose of 4000 cGy at the apex in about 90 +/- hours. If the tumor is abutting or close to the optic disc, use a notched plaque instead.
How would you approach a small, node-negative (cT1-2N0) nasopharyngeal cancer in a patient with prior H&N cancer treated with surgery and radiation?
RT to primary and RP nodes. Positive nodes in previously irradiated neck likely 10% or less, so I’d observe neck.
How do you approach treatment of an unresectable sacral chordoma?
Definitive RT, preferably with protons.