Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider perioperative chemotherapy in an anastomotic recurrence of gastric cancer after partial gastrectomy who did not receive prior chemotherapy or radiation?
My practice is to treat this exactly like de novo locally advanced disease. This means that the patient needs to be carefully (re-)staged, including with PET/CT scan, possibly an EUS, and most importantly, a diagnostic laparoscopy. Recurrence at the anastomosis can certainly also be associated with ...
How do you manage a patient with isolated local recurrence of head and neck cancer with a pharyngocutaneous fistula within previously irradiated field?
Resection if feasible (unlikely) or palliatively.
If CBCT is not an option, what is your preferred IGRT strategy for prone breast patients?
We have never used CBCT for whole breast prone patients. Daily lateral MV is our standard approach + weekly ports. Could consider KV daily, as well.
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 ...
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?
I manage the pain control 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...