Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What makes a daily huddle successful?
Intention of a daily huddle is to quickly make the team aware of issues either seen yesterday needing attention, and anticipating such issues today, identifying other outlier events or variations impacting your team/department, and brief review of the day (e.g. staff changes, coverage, special proce...
How should a patient with perforated H. pylori negative gastric MALT be managed?
Generally, the treatment for H. Pylori neg gastric MALT of limited stage is radiotherapy, dose 24-30 gy. The question presumably concerns the influence of a history of perforation on that recommendation. Data are limited but radiation induced gastric or intestinal perforation when treating lymphoma ...
When you treat postop head and neck cancer, do you typically add a CTV margin to the delineated postoperative bed, or just treat postop bed plus PTV margin?
We don't ever have a CTV margin. It is postop bed which accounts for all pre-surgery GTV and all postoperative changes on imaging, also review the op note and path. We then add a 3-5mm margin to account for set-up.
Would SBRT be recommended for a non-surgical isolated para-aortic recurrence in the setting of metastatic papillary serous ovarian cancer residual disease after systemic therapy?
There are multiple retrospective single institution and combined multi institutions studies showing RT in this setting (either SBRT or regional IMRT based on clinical scenario and nodal recurrence pattern) leads to excellent index cancer control. It prolongs chemotherapy free interval and progressio...
How do you manage muscle pain and irritation due to radiation?
One can start with NSAIDs. If it is not effective, one can proceed to use a Medrol Dose Pak or dexamethasone 4 mg QD. If it is pain flare, one can start with steroids.
Are cold spots on an external beam plan due to prostate fiducials concerning?
The dosimetry around fiducials is complex, with both some minimal shielding and increased dose due to scatter coming into play. Honestly, I'm not sure how accurate the planning system algorithms are in determining dose in the immediate vicinity around the typical tiny fiducial. On balance, I think t...
How would you treat an unresectable verrucous carcinoma invading the anal sphincter?
Would treat with same plan and intent as typical squamous cell cancer with chemo option being xeloda and MMC or xeloda and cisplatinum.
Would you consider radical prostatectomy for a young male with unfavorable intermediate risk cT3a prostate cancer and PSMA PET concerning for regional lymph nodes involvement but negative conventional imaging?
I would approach this scenario by considering two main issues. The first issue is what the probability of the patient truly having pN+ disease based on cN+ findings on advanced imaging. There have recently been two trials published from the Netherlands, PEPPER (using 68¸Ga-PSMA-11) and SALT (using 1...
Can adjuvant nivolumab for bladder CA as per Checkmate 274 be extrapolated for the concurrent chemoRT bladder preservation setting?
Great question. Short answer is no. Different scenario and very hard to extrapolate from the adjuvant post radical cystectomy setting. We need dedicated bladder preservation trials, e.g. S1806 and Keynote992. Recommend to accrue in those 2 large phase III trials for patients who opt for bladder pres...
Would you treat the pelvis in a high risk prostate cancer patient who is anticipating pelvic kidney transplantation?
My decision to treat pelvic nodes depends on the specific risk criteria present, but let's assume that this patient meets those criteria. In this situation, it is important to discuss the options for locating the vascular anastomoses with the transplant surgeon. Typically, these would involve either...