Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend consolidative radiation therapy to an isolated frontal dural MALT lymphoma after complete response to chemotherapy?
I would treat this with ISRT principles with generous dural margins to 24-30 Gy.
How do you manage androgen deprivation in a patient with oligometastatic prostate cancer in which the primary and all known metastatic sites have been treated with curative intent radiation and PSA remains undetectable?
A great question and one that we don't have data for yet! In the absence of data, we can fall back on what we know about prostate cancer and its response to radiation and hormonal therapy, and remember the goals of treatment. Studies in the localized setting combine ADT with RT for 3-26 mo, with len...
What MRI sequences do you utilize for spine SRS treatment planning?
T1 pre contrast scans are helpful for identifying disease that involves the marrow spaces. I would recommend a 3D post contrast T 1 series for identifying extraosseus disease such as epidural or paraspinal extension of disease. Fat suppressed sagittal T2 weighted images can be helpful in assessing t...
Would you recommend re-irradiation to the pelvis for palliation of bone metastases in a patient who previously had prostate brachytherapy?
Great question. So a patient with prior brachy only for his prostate cancer needs palliation for bone met in the pelvic region. I guess my first question would be what type of implant HDR/LDR and at what time did he received the implant? Dose of implant too! What is his clinical state: Age / KPS / c...
How long do you continue surveillance imaging for NSCLC after definitive treatment?
Theoretically, many of these patients would likely have the risk factors to qualify for ongoing low dose CT chest surveillance well after addressing their pulmonary malignancy.https://www.ncbi.nlm.nih.gov/pubmed/21714641
Is it feasible to give pelvic radiotherapy in patients with a congenital, functioning, pelvic kidney?
Agree with @Dr. First Last Pelvic kidney is not necessarily a contraindication to radiation with modern (e.g. IMRT) RT planning Lots of teaching cases and case series For these patients, we first make sure treatment to the pelvis is absolutely necessary. Treatment planning is done with high priority...
How does the presence of active rheumatoid arthritis on rituxan impact your decision to proceed with prostate radiation?
I am always concerned about irradiating a patient with an active chronic inflammatory condition, as these people may be more prone to toxicity, both acute and late. In the case of a patient with both prostate cancer and rheumatoid arthritis, the latter being treated with rituximab, the fact that he ...
How do you deal with worsening tinnitus in patients on concurrent chemoradiation with weekly cisplatin for head and neck cancer?
Based on data from three studies at our institution whereby we interchanged Carboplatin when cisplatin toxicity was induced, I would substitute weekly Carboplatin (AUC 2) IV weekly with the remaining RT.
How would you approach a mucinous adenocarcinoma of the anal verge without anal canal involvement, status post excision with positive margins but without the possibility of additional surgery?
The nodal drainage is dependent primarily on the anatomy and not the histology (the histology can determine the likelihood of nodal spread). If the tumor is truly not involving the anal canal one has to assume that this is a cancer originating in the skin and I would manage it as a skin cancer. The ...
How would you manage a patient with Lynch syndrome who is s/p surgery and pelvic RT 20+ years ago for endometrial carcinoma with a new T3N0M0 squamous cell carcinoma of the anus?
I have treated some patients like this with cancer of the vulva with previous EBRT. I would limit the dose and volume based on overlap and focus on the area at highest risk like the primary and groins.