Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a previously irradiated localized recurrence of an adenoid cystic carcinoma of the nasopharynx?
Assess resectability. If not suitable for gross total resection, and likely not, protons.
Would you recommend consolidative radiation therapy for advanced stage bulky Hodgkin's lymphoma with a delayed complete response after 6 cycles of A-AVD chemotherapy?
I suppose I have three comments about this question.First, the sensitivity (percentage of true positives) and specificity (percentage of true negatives) are generally higher than the positive predictive value (true positives/all positives) for end-of-treatment PET-CT in lymphoma. In one study, the P...
How would you manage prostate cancer in a patient who received prior chemoradiation followed by an APR for rectal cancer?
Patients who have been treated with chemoradiation followed by an APR for rectal cancer and now have prostate cancer and are not surgical candidates do have definitive treatment options despite the previous treatment. Although HDR brachytherapy is usually a great option for patients who have already...
Which cisplatin regimen is preferred for concurrent chemoradiation for definitive treatment of muscle invasive bladder cancer?
I tend to use 35 - 40 mg/m2 once weekly, ideally on Mondays (I think that SN1806 is using 35 mg/m2 weekly).
How do you manage a stenotic airway following SBRT or hypofractionated radiation to a central lung tumor?
I haven't read much about this in the literature and my quick search doesn't reveal much about it either. So, I'll give you my clinical wisdom on it and you can take it with a bunch of grains of salt. The issues that I've faced with a stenotic airway have been in the context of shortness of breath a...
For invasive ductal carcinoma with micropapillary features s/p lumpectomy, is bolus needed when treated with adjuvant whole-breast RT?
When using WBI, I don't typically bolus tangential fields. If superficial cavity and you are concerned about dose to cavity, I try to use 6 MV photons for tangents. For very superficial cavities, if you want to be sure, you can MOSFET over lumpectomy incision and if low, can add bolus over the incis...
What dose constraints do you use for OARs when treating with breast IMRT?
We follow dose constraints from ongoing NRG studies of breast plus RNI with the only difference being, to focus more on dose homogeneity and make sure V 105 for ipsilateral breast is <10%, and mean heart dose of heart and LAD if possible, below 2 Gy.
What would be your post-operative therapy approach for a high grade neuroendocrine carcinoma of the thymus?
Postoperative RT.
How soon after valve replacement would you start thoracic radiation for NSCLC?
Depends on the valve replacement method, if open heart, then one would need to wait until the scar has healed. If done transcatheter, one could start much sooner. I'm not aware of any data regarding outcomes and timing RT post valve replacement. Most of the data I've seen is for patients who had pri...
How does urinary obstruction impact your choice of therapy for metastatic or locally advanced prostate cancer?
Bladder outlet obstruction due to locally advanced prostate cancer is typically due to bladder wall and ureteral orifice invasion and T4 disease. These patients can suffer from pain and urinary obstructive symptoms for long periods of time despite the use of ADT, ADT plus AR inhibition, or ADT plus ...