Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Given the biochemical failure definition of PSA nadir+2 ng/mL, how do you approach a PSA bounce of magnitude 2 ng/mL or higher?
If a PSA bounces >2 points then PSA decreases subsequently without any treatment, I do *not* consider these patients to have failed. This does occur in the clinic occasionally. Thankfully, when patients have rising PSAs after RT, there usually is not an urgency to start salvage treatment. When a pat...
How do you manage urgency and frequency of bowel movements secondary to radiation proctitis?
In the acute setting we try anusol HC suppository to decrease tenesmus like symptoms
How do you optimize HDR brachytherapy for intracavitary treatment of cervical cancer?
We do image based brachytherapy (MRI based). Start with standard weighting for point A dose and there after manually adjust dwell times to get D90> or = 100% and cumultative D2cc for rectum 65 Gy or less, Bladder 80 Gy or less and sigmoid 70 gy or less With weightedd planning, majority of times dose...
What is the recommended management for a large unresectable intracranial hemangiopericytoma?
Although beyond the scope of this discussion, it is important to recognize the evolution of the pathological classification of hemangiopericytoma. Solitary fibrous tumor and hemangiopericytoma are now considered histopathological phenotypes of a single pathologic entity. However, past studies typica...
How do you approach a lung malignancy with a single pleural nodule near a primary?
This is a relatively rare scenario. For example, in a Korean series of almost 4,000 patients undergoing surgery for NSCLC, 78 (2%) were found to have unexpected pleural seeding intra-operatively (Thorac Cardiovasc Surg 2018;66:142). A small number of surgical reports suggest, that when limited seedi...
Do you treat early stage breast cancer patients with hypofractionation in the prone position?
Yes as there is no reason not to do it
Would you de-escalate therapy for a prostate cancer that is barely high risk and has only 1 of 12 cores positive?
First let’s discuss high risk for cancer at the low-end of that category (example a T1c PSA6 1-2 core GS 8). Current standard of care for radiation management is to provide at least 18mo of ADT based on PCS-IV. This is somewhat of a dose de-escalation of hormonal therapy compared to EORTC regimen. ...
What would your RT volumes be for a high grade sarcoma of a joint (such as the knee) after a gross total resection?
Receiving patients in the post-operative setting can be saddening knowing that a pre-operative regimen of radiation would be a lesser dose and volume resulting in a lesser chance of late-term toxicity as shown in the long-term follow-up of the NCIC study comparing pre-op versus post-op radiotherapy....
Do you recommend post-operative radiation therapy for gastric cancer after pre-operative chemotherapy when there is no pathologic response to chemotherapy?
There is no level one evidence to support such a recommendation. One could argue this point either way. The counterargument is that poor response to chemotherapy predicts poor outcomes in gastroesopheal cancer and a local therapy will not change that. That is certainly the case for GEJ ACA who all g...
How would you treat a patient with a solitary prostate cancer metastases in the mandible?
This would be a very unusual situation, as metastases to the mandible generally occur late in the course of the disease. I would want to be as certain as possible that this really represents prostate cancer, and would get a biopsy. The biopsy not only would confirm the diagnosis, but also permit you...