Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For cervical cancer intracavitary brachytherapy, do you use contrast when using CT-based planning to better visualize the ureters?
We normally do MRI based planning and the ureter can be identified and contoured on MRI. For only CT based, we do out diluted contrast in bladder for bladder contouring but do not go to the ureter. Rodríguez-López et al., PMID 33065181Koerner et al., PMID 34980569
How do you prefer to manage multiple or numerous symptomatic skull metastases in a patient without brain metastases?
If it is painful, I would locate the areas that appear the most painful and "spot weld". I.e. - if there is a constellation of lesions on the right temple that can be encompassed with an electron field, I would treat that. Or, around vertex and can possibly do tangents. If there are virtually all o...
Is it reasonable to use hypofractionation in breast cancer patients with non-active connective tissue disorders?
Yes, it is reasonable to use hypofractionation in this patient panel. I have used the Canadian fractionation schedule several times in this scenario.
For a patient obtaining significant benefit and no side effects from pentoxifylline/Vitamin E for radiation-induced vulvovaginal fibrosis, do you continue treatment longer than 6-7 months or discontinue?
I reassess these patients at 3 and 6 months, regardless of site (gyn or breast). If the patient is benefitting from the trental/vitamin E but still has significant fibrosis, I continue these meds for up to 2 years.
What are your shift tolerances for fractionated SBRT and SRS treatments?
I generally use Shift more than PTV margin as an indication for repeat imaging.
Do you routinely boost the lumpectomy cavity for HER2-positive breast cancer in the absence of other risk factors?
I do tend to boost although absolute benefit for node negative favorable ER PR positive her2 neu positive breast cancer is probably minimal. For these patients, we also offer APBI routinely.
How would you treat a locally recurrent NSCLC abutting the heart that was previously treated with conventional chemoRT?
Like any reirradiation case, there is no one correct answer regarding this difficult scenario. The amount of time elapsed since prior RT, how much dose was received by the heart from the conventional treatment, cardiac/pulmonary comorbidities, life expectancy, performance status, other medical/surgi...
Would you cover presacral lymph-nodes in endometrial cancer patients with locally advanced disease (IIIC2 disease) who received neo-adjuvant chemotherapy prior to resection with no residual disease on pathology?
For IIIC2 endometrial cancer, we have included presacral lymph nodes routinely. There are no studies to compare with and without presacral lymph to my knowledge.
For a lymph node negative nasopharyngeal EBV(+), cT3N0, what lymph node levels would you electively cover after a good response to induction chemotherapy?
I think one can consider omitting the low neck for N0 neck. I would make sure restaging scans are done prior to the start of radiation post induction chemotherapy.
Is history of radioactive iodine treatment for thyroid cancer a contraindication to receive XRT for prostate cancer?
Not a contraindication. Thyroid patients can get multiple rounds of RAI, and be eligible for external beam to the HN area, so there would be no contraindication in other sites of the body.