Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage asymptomatic radiation necrosis in a glioblastoma?
If a patient is not symptomatic from radiation necrosis, the only thing that would make me consider initiation of dexamethasone (Consideration of Avastin reserved for symptoms refractory to steroids) would be significant midline shift that is progressing, but this is usually going to lead to symptom...
Would you consider continuing a biologic for difficult to control autoimmune disease in a patient with a recent diagnosis of a surgically curable solid malignancy?
There continues to be relative uncertainty regarding the management of biologic therapy in these patients. As treating physicians, this scenario is not uncommon where a decision to continue or stop a biologic has to be made in face of solid malignancy. A detailed review of individual circumstances t...
In a patient with a remote history of mantle field radiation, is there any contraindication to whole breast irradiation for early stage breast cancer?
It’s not an absolute contradiction depending on prior mantle dose and volume. That being said, would favor PBI over whole breast if disease suitable for PBI. One concern about the risk of new primary at other site in breast remains as had mantle RT and a need to be counseled.
How long do you wait before performing liver-directed therapy on a colon cancer patient with liver-only disease and prior radiation-induced liver injury ?
How long after completion of radiation therapy should patients continue fluoride treatment for dental health?
Indefinitely
What radiation strategy do you use in clinically node positive pancreas cancer responding to neoadjuvant chemotherapy?
For locally advanced disease or any situation where the surgery is not a definite option, we recommend ablative radiation (100Gy BED equivalent). That includes an ablative dose to the GTV imbedded within a microscopic dose PTV that includes wide coverage for microscopic extension to nodes along vess...
How do you approach sequencing of systemic therapy and radiation in NSCLC with epidural invasion?
Assuming that there are no targetable mutations in this case, I would give chemo and RT concurrently if possible, since optimal local control is essential in these scenarios to avoid tumor causing worsening epidural disease and symptomatic cord compression, accepting a low risk of radiation-induced ...
What adjuvant therapy would you offer for rectosigmoid junction adenocarcinoma after initial LAR?
The ideal treatment of rectosigmoid cancers is often nebulous, as depending on their presentation, they can be approached like rectal cancer or colon cancer.Given that this patient had initial surgery, I would approach this patient as a higher risk stage 2 colon cancer, based on the perforation as w...
For someone with asymmetric Graves ophthalmopathy, do you still treat both eyes, or target the single affected orbit?
Single site.
When treating whole breast, how do you minimize contralateral breast dose without sacrificing coverage and lung/heart dose?
In terms of minimizing contralateral breast dose, it starts in simulation for me. I try to make sure the contralateral breast is as far away from where medial tangent will enter. If contralateral breast is close, you can consider taping it away. For tangents only or tangents with SCV (without IMN): ...