Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For lymphoma, how long after chemotherapy can you wait to start consolidative radiation therapy?
My general practice is to have patients return 3 weeks after their last cycle of chemotherapy with labs and post-treatment imaging and then proceed with consolidation RT. Depending on the complexity of planning, I am generally starting RT ~4-5 weeks after their last cycle of chemotherapy. This is co...
Would you use radiotherapy (including SBRT) in a patient with locally advanced pancreatic cancer who has multiple cystic structures in the pancreatic head on imaging, possibly due to pancreatic leak, but is asymptomatic?
Possible pancreatic leaks would not change my treatment recommendations. Pre-op chemoradiation has been reported to reduce the incidence of PJ leaks by reducing the exocrine output (Lowy et al., PMID 9389397), so it could be helpful if that is what is causing the cysts.
Would you give postop RT for a patient with PVNS (pigmented villonodular synovitis) of the knee after a total knee replacement with total synovectomy?
No. The total knee replacement allowed for a true "total" synovectomy.
For women who have difficulty healing after a mastectomy but need adjuvant radiation therapy, is there an amount of time for which you would abandon plans for radiation?
While there are data on this topic, there is no clear consensus. Typically, if the patient is not receiving any therapy (ex. post-neoadjuvant chemotherapy patient), I try to initiate RT within 3 months of surgery. On occasion, I have pushed to 4 months but ideally 3 months though, there is some data...
When discussing prostate cancer treatment options, how do you address that surgery side effects are considered acute and radiation side-effects are long lasting?
Stress urinary incontinence as well as ED can last a lifetime after surgery. So, both have acute and late effects. Also since urologists don’t typically (never in my experience) order an MRI prostate, they can expose patients to additional surgical and adjuvant radiation toxicity. If I see a patient...
Would you consider adding adjuvant vaginal cuff brachytherapy for a FIGO 1A endometrial cancer, G1, no LVSI, based on the presence of extensive lower uterine segment involvement?
It’s not an absolute indication for adjuvant brachy with small absolute benefit.
Do you account for dose from previous Lu-177 treatment for definitive prostate cancer treatment?
The short answer is yes. You'll have to assume that the entire bladder epithelium received that dose. However, due to dose rate effects, the equivalent dose to what would be delivered using external beam radiation will be less than 12.8 Gy. You should try to estimate an EQD2 for the Lutathera treatm...
In a patient s/p lumpectomy+RT for an early stage breast cancer, who later has recurrent disease requiring mastectomy and PMRT, under what circumstances would you recommend a boost?
If already had WBI and now requiring PMRT, I only boost for positive margins, inflammatory recurrence, or if skin involvement.
What would be your approach for a patient with triple negative metastatic breast cancer with oligo-progressive disease in the axilla alone?
Would evaluate with breast surgeon. Can consider surgery if other disease stable for > 6-12 mo, followed by +/- RT. Important to consider if primary was already treated and if this is on ipsilateral/contralateral side.
How would you proceed when a cervical cancer undergoing brachytherapy has exceeded the rectal dose but not met the target dose?
Rectal dose and target dose have range. Preferred rectal dose for D2cc < 65 Gy but can accept up to D2cc < 75 Gy, provided you understand expected risk of complications with increased dose. Preference would be to do hybrid applicator with 3D imaging to optimize HRCTV and OAR.