Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you utilize a V80Gy dose constraint for the rectum for definitive dose-escalated RT of the prostate?
I generally treat to 78 Gy in 2 Gy fractions or to 79 Gy in 1.8-2 Gy fractions, so I'm very concerned about hot spots and where they are located. I try hard to keep the rectal Dmax less than 80 Gy. That's not always possible. I will accept max doses up to about 82.5 Gy if the volume is not more than...
How long after WBRT would you wait to give SRS to a recurrent brain metastasis?
Practically speaking, radiation necrosis from whole brain radiation is very unusual. So most progression post whole brain radiation would be considered tumor recurrence and may be best treated with SRS. With newer immunotherapeutics, however, pseudoprogresion may be seen and needs to be considered. ...
Are there contraindications to giving radium-223 concurrently with palliative radiotherapy or systemic chemotherapy for mCRPC?
These combinations have not been approved, but studies of radium-223 with taxane therapy have been conducted in concert with docetaxel and have been presented in 2017 at GU ASCO by Michael Morris. These studies show that the combination is promising but myelosuppresive. The response rates to combine...
What is your treatment approach for patients with ampullary carcinoma who are poor surgical candidates but otherwise eligible for curative-intent therapy?
Patients with luminal gastrointestinal tumors including ampullary adenocarcinoma are only eligible for neoadjuvant and palliative doses of radiation because of the tolerance limitation of the surrounding GI mucosa. Although long-term survival is possible without surgery, there are no data documentin...
Is there an effective treatment for multiple appearances of cutaneous Kaposi's lesions besides radiation?
Unfortunately, there is no established effective treatment for multiple appearances of cutaneous Kaposi's lesions. Radiation therapy seems to work if the dose is adjusted well. Radiologists are very familiar with this. However, there are often out-of field recurrences which are difficult to treat. ...
How do you manage a rib fracture caused by SBRT?
Chest wall pain, with or without a radiographically evident rib fracture, is an infrequent complication of SBRT--and, it should be remembered, rib fracture is also an infrequent complication of conventionally fractionated RT, reported in numerous series of patients treated with RT to the breast/ches...
What is your treatment approach for re-irradiation of a pituitary adenoma?
Re-irradiation for a pituitary adenoma is very challenging situation, since almost certainly would exceed normal tissue tolerance of optic apparatus. If re-irradiation is deemed necessary, stereotactic radiation either SRS or SRT should be used. Stereotactic RT only need minimum margin, usually 0-2...
What treatment volume is appropriate when treating postoperatively for esophageal carcinoma?
Unfortunately there is no simple answer to this question. First, one should realize that there are basically three ways in which local recurrences tend to occur, and one must ask which one (or more) of those is relevant for the individual patient. First, tumor can recur because there is residual nod...
Do you ever recommend PCI for large cell neuroendocrine cancer of the lung?
No. There is no established benefit as there is not the propensity to brain failure nor reduction in brain relapse or improved survival. There is a reduction in brain relapse in other NSCLC, but without improved survival.
When treating the regional nodes, what factors cause you to treat the lower axilla?
The two most important factors in node positive patients when we consider in treating level 1 and 2 axilla is inadequate dissection (this includes pts with sentinel node bx only) and a high percentage positivity (50% or more node positive ) in patients with an adequate dissection (10 or more node ta...