Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the preferred radiation delivery technique for whole abdominal or flank RT in childhood cancers?
The rationale for using less sophisticated techniques to treat flank and whole abdominal fields has largely been centered on reducing the potential for growth discrepancies by treating with homogeneous doses across bony structures, most notably the spinal column and pelvic bones. The use of AP/PA fi...
Are you using the commercially available Naveris assay for HPV+ OPX cancers in your practice?
Our practice at Emory is to get this at initial consult for all HPV+ oropharyngeal cancers so that we can establish if ctHPVDNA is positive (as it is not positive in all HPV+ cases). Right now, I find it most useful at the three month scan in equivocal cases, a negative ctHPVDNA leads us more towar...
How would you approach a patient with gastric MALT lymphoma who has CREST syndrome?
The quick answer is, very carefully. To elaborate - I first had to look up what CREST syndrome is - the short answer is limited extent scleroderma, usually the distal upper and lower extremities, but occasionally the head and neck region and most relevant to this question, the esophagus. The literat...
How would you approach the treatment of an elderly patient with dementia, with multifocal pT1b IDC s/p lumpectomy, with extensive DCIS, and medial margin positive for DCIS?
It would be a function of her expected survival from dementia (geriatric assessment) and will her breast cancer be an issue in her lifetime based on the assessment. Based on that option, could be nothing to AI or RT.
When do you use a bite block for H&N cases?
It’s remarkable that despite all the technological advancements in radiation delivery, simple oral management solutions can make a bigger impact on the dosimetry. They have two primary functions: Create favorable anatomic relationships for OAR sparing Enhance stability and reproducibility ...
When do you include the neck in the RT field for resected thyroid cancer?
I will use external beam RT to the neck for medullary thyroid cancer, anaplastic thyroid cancer, or local-regional recurrence of papillary or follicular that is no longer iodine-avid, and thus cannot be treated by I-131.
How soon after completion of salvage RT to the prostate bed do you allow urethral dilation?
In my experience, anastomotic strictures do not resolve spontaneously or with treatment interruptions. In part, the answer to this question depends on how symptomatic the patient is and how close you are to the end of treatment. If the patient is totally obstructed or close to it, you're probably go...
Would you consider SBRT and adjuvant therapy for a 4cm, node-negative, non-oncogene driven, NSCLC not amenable to surgical resection?
Ultimately, currently open clinical trials will address this question (i.e., SWOG-S1914, NCT04214262). In the absence of this, there have been several questions here on this topic ranging from the possible role for adjuvant chemotherapy, incorporating ctDNA testing, and how to follow these patients ...
How do you manage a patient with early stage small cell carcinoma of the breast?
Few I have treated had outcomes similar to SCC at other site. Since surgery is already done, they all get PE chemotherapy and we follow up with whole breast hypofractionation RT.
Is it reasonable to omit nodal RT in an elderly patient with T3N0 SCC of the glottic larynx?
I would not omit ENI. It’s less morbid than a neck failure.