Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer preoperative radiation therapy when treating retroperitoneal sarcomas?
STRASS is a landmark trial and the authors deserve warm congratulations for completing a study of this scale in a rare disease. Its results are very important, but they also must be analyzed thoughtfully and taken in context.Several initial points: The primary endpoint was abdominal recurrence-free ...
Are there any special radiotherapy considerations for women who have double lumpectomy?
Z11102 looked at multiple ipsilateral breast cancers and lumpectomies. For these cases, I would be fine with hypofractionated WBI. Boost would be based on features of each cancer so if it was otherwise low risk for both, I would omit boost vs. if both were higher risk (< 50, ER-), I would boost both...
In the setting of adjuvant treatment for locally advanced oral cavity cancer, would you offer altered/hypofractionated courses for elderly patients with lower functional status?
At our institution, elderly patients with locally advanced oral cavity cancers who are treated with curative intent oncological resection are typically also treated with curative intent conventionally fractionated adjuvant radiation based on pathological risk factors. For elderly patients with lower...
How would you manage gastrointestinal bleeding after radiation therapy for pancreas cancer?
In our ablative RT experience (100Gy BED, Reyngold, JAMAOncology, in press), we have had a 2.6% rate of bleeding possibly related to RT in patients not on anticoagulation and 15% in patients are on anticoagulation. Using the point dose constraints (60Gy in 25# and 45Gy in 15#), we have typically see...
When do you recommend prophylactic treatment of spinal metastasis(-es) after initial identification on staging imaging for a metastatic solid tumor?
The closest thing that I have done to prophylactic spinal (vertebral body) treatment would be if someone has a symptomatic spinal metastasis very close (within 2 vertebral bodies) that is going to have radiation treatment. I might include the asymptomatic one so that later there is less probability ...
Can hydrogel spacer be placed in a previously irradiated pelvis if considering prostate radiation by brachytherapy or SBRT?
The simplest answer to your question is “maybe”. Spacers have been placed in previously irradiated patients. You won’t know until you attempt to hydrodissect during the procedure.
What is your approach for a PMRT patient that cannot tolerate prone or supine sim with necessary arm positioning?
In terms of tolerating simulation following mastectomy, the most common issue I have faced is raising the arm. One option is to try a referral to breast therapy to assist with range of motion, cording as needed. If the patient is still unable to raise arm needed for prone/supine, as needed, I have u...
How should young patients with rhabdomyosarcoma be managed in the absence of a clinical trial?
The guiding principles of disease control while maintaining form, function, and quality of life drive the decision-making and management for patients with rhabdomyosarcoma.Regarding patients with paratesticular primary, inguinal orchiectomy with no scrotal invasion but tumor on the surface of the re...
How would you manage a premenopausal female with stage I triple positive breast cancer who is asymptomatic and tests positive for COVID mid way through radiation therapy?
I think there are a few options here: 1. Break the patient and resume when cleared per your institution's protocols. I typically consider adding a fraction for every 5 days of delay. So, if it is 10-15 days for example to when she is cleared, then add 2-3 fractions. 2. Continue to treat patients per...
In a patient treated with chemoradiation therapy for anal cancer 10+ years ago who presents again with localized anal squamous cell carcinoma, would you consider repeat chemoradiation for organ preservation instead of APR since so much time has passed since the first treatment?
Usually no, and APR would be the most appropriate treatment option once all factors are considered. However, for small localized tumors, brachytherapy for local control may be considered but discussion regarding sphincter control is paramount as it may be compromised post reirradiation.