Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What image guidance do you use when treating rectal and anal cancers?
For anal cancer, daily CBCT for the first three fractions to evaluate bladder filling mostly (and to make sure there's not surprise excessive gas in the anus/rectum). After that, KV daily and CBCT weekly. If treating with a vaginal dilator in, I may CBCT more frequently to evaluate its position.
In what situations would you consider treating metastases to the spine with proton SBRT?
For any question I must rely on evidence to answer it. So the first thing is- what is the published data on the use of proton SBRT for spine metastasis (not primary spinal cord tumors)? I am unaware of any outcomes data, and after a quick pubmed search I found zero papers (not even retrospective out...
Do you consider a dose constraint to the phrenic nerve during lung and liver SBRT?
This is a very interesting question for which I can not provide a ready answer since to my knowledge, there are no series or case reports that have specifically identified phrenic nerve injury associated with a course of SBRT. I would suggest that establishing constraints for this nerve would likely...
What LN stations would you advise covering for lung adeno with + LN at level 9 s/p lobectomy + LND?
Data from the Lung Adjuvant Radiotherapy Trial Investigators Group (Lung ART) are forthcoming, as the trial recently completed accrual I think). In the interim, their protocol is quite helpful in determining which nodal stations to include post lung resection, when adjuvant RT is deemed appropriate....
What is the general practice for patients that have SpaceOAR placed and then have a delay to treatment start?
I have not encountered this problem yet. Theoretically the SpaceOAR begins to hydrolize after 3 months and completely reabsorbs between 6 and 8 months. The delay would have to be significant due to a major medical event or accident. If the SpaceOAR has completely disappeared it could be reinjected a...
For a R0 resected large inverted papilloma of the maxillary sinus with invasion into multiple surrounding structures but only a small malignant portion, would you cover the entire papilloma extent or only the malignant portion post-op?
Interesting question. It is very hard to accurately map out where the malignant portion is. I would treat the entire postop cavity to 60-66Gy.
How do you manage a patient who develops Lhermitte's sign?
Reassuring the patient as usually it is self limiting short lasting condition from transient changes in the cord
Should patients with idiopathic pulmonary fibrosis be placed on nintedanib or pirfenidone before starting radiotherapy for lung cancer?
This is an interesting question but this is a small patient population in our practice and we have not initiated either drug in the setting of IPF to prevent possible radiation related side effects to the lung because we are unaware of any information to suggest that there would be a benefit.
Would you recommend radiation planning with air tissue expanders in patients who will receive PMRT?
I would suggest removal of air or replacement with fluids for dosimetric reasons.
Should definitive concurrent chemoRT be offered to patients with anal canal SCCa with common iliac nodal involvement (by definition M1 disease) without evidence for other distant disease?
Very simply, the answer is yes. I would treat this patient aggressively. Nowadays we treat for cure many patients who have a formal M1 staging, and this patient fits into the same category. There is no clear answer as to how far proximal the nodal treatment should go, probably into the mid-paraaorti...