Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose/fractionation scheme would you use for a bulky (>15 cm) metastatic renal cell carcinoma deposit with brachial plexus encasement and spinal canal invasion?
This is a remarkably complex clinical scenario where standard approaches are not likely to achieve the palliative response desired. Therefore, we would approach this challenging clinical situation with highly tailored and compact as possible SBRT-like fields using a dose fractionation of 800 cGy per...
Would you consider definitive radiation therapy (EBRT + interstitial HDR) in lieu of pelvic exenteration for a vaginal spindle cell sarcoma?
I would not favor definitive RT unless not a surgical candidate but sometimes have been able to do EBRT plus brachy after gross total excision to avoid exenteration.
What dose/fractionation would you use to treat a papillary thyroid cancer with bulky cervical adenopathy and laryngeal invasion with impending airway obstruction that is refusing laryngectomy and surgical management?
I have encountered this situation at times and assuming the patient has a tracheostomy and there is no way to convince them to undergo the recommended surgery, I have offered definitive radiation therapy. I have treated a number of patients with 70/63/56 Gy in 35 fractions ensuring coverage of level...
How do you approach management of non-resectable periampullary adenocarcinoma in an elderly patient with otherwise good PS?
The level of evidence is more limited to guide treatment decisions for ampullary/peri-ampullary adenocarcinoma compared to the neighboring pancreas. However, I have generally approached this situation similarly to locally advanced or inoperable pancreas cancer starting with systemic therapy and if t...
How you do approach adjuvant radiation recommendations (RAI and EBRT) for papillary thyroid carcinoma, tall cell variant status-post total thyroidectomy?
TCV remains the most common high risk pathological variant of well differentiated papillary thyroid cancer and often is associated with a BRAF mutation, which makes it more likely a target for systemic therapy if and when it recurs.From a postop RT perspective, it is more likely to recur both at the...
For lymphoma, how long after chemotherapy can you wait to start consolidative radiation therapy?
My general practice is to have patients return 3 weeks after their last cycle of chemotherapy with labs and post-treatment imaging and then proceed with consolidation RT. Depending on the complexity of planning, I am generally starting RT ~4-5 weeks after their last cycle of chemotherapy. This is co...
Would you use radiotherapy (including SBRT) in a patient with locally advanced pancreatic cancer who has multiple cystic structures in the pancreatic head on imaging, possibly due to pancreatic leak, but is asymptomatic?
Possible pancreatic leaks would not change my treatment recommendations. Pre-op chemoradiation has been reported to reduce the incidence of PJ leaks by reducing the exocrine output (Lowy et al., PMID 9389397), so it could be helpful if that is what is causing the cysts.
Would you give postop RT for a patient with PVNS (pigmented villonodular synovitis) of the knee after a total knee replacement with total synovectomy?
No. The total knee replacement allowed for a true "total" synovectomy.
For women who have difficulty healing after a mastectomy but need adjuvant radiation therapy, is there an amount of time for which you would abandon plans for radiation?
While there are data on this topic, there is no clear consensus. Typically, if the patient is not receiving any therapy (ex. post-neoadjuvant chemotherapy patient), I try to initiate RT within 3 months of surgery. On occasion, I have pushed to 4 months but ideally 3 months though, there is some data...
When discussing prostate cancer treatment options, how do you address that surgery side effects are considered acute and radiation side-effects are long lasting?
Stress urinary incontinence as well as ED can last a lifetime after surgery. So, both have acute and late effects. Also since urologists don’t typically (never in my experience) order an MRI prostate, they can expose patients to additional surgical and adjuvant radiation toxicity. If I see a patient...