Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What radiation sensitizer do you recommend for early stage poorly differentiated squamous cell carcinoma of the anus, in a patient with stage IV chronic kidney disease?
I have used carboplatin (AUC 2 weekly) + 5-fluorouracil in this setting with good tolerance. I acknowledge that the substitution of carboplatin for cisplatin is largely an extrapolation from the approach to squamous cell carcinomas of other primary sites. However, I feel very comfortable with this s...
How would you treat maxillary ameloblastic carcinoma s/p R1 resection and perineural invasion?
Treat like a squamous cell carcinoma. 66-70 Gy at 2 Gy per fraction. Treat to the skull base. Consider protons depending proximity to visual apparatus. Electively treat the neck.
What dose and fractionation would you use for definitive intent radiation therapy for a metastatic melanoma of the maxillary sinus?
Paranasal sinuses (PNS) are common sites for primary mucosal melanoma of the H&N, which is itself a rare entity in comparison with their cutaneous counterpart but of even more aggressive nature. Thus, I wonder if this is actually not a metastatic setting you're facing. Even if there were other melan...
Would you stop hydroxyurea for thrombocytosis in a prostate patient receiving radiation?
In cervical cancer literature, when hydroxyurea was used with RT as a radiosensitizer, acute side effects were significantly increased, including myelosuppression. I would consider holding it during RT.
How would you approach an unresectable locally advanced lung cancer invading the chest wall 25 years after whole breast radiotherapy to the same side?
The first thing to evaluate is the location of the current tumor and treatment fields for previous breast radiation. It's unlikely to get a full treatment plan, but if you can get dose, fields, and if you are lucky, some kind of field set up, you might be able to "recreate fields". If it was whole b...
What dose of radiation would you give for an orbital psuedotumor?
20 Gy/10 fractions.
What dose-fractionation would you utilize for an unresectable localized cutaneous melanoma that has progressed on immunotherapy?
If the concern is to minimize the chance of radiation-induced brachial plexopathy, then it is advisable to keep the equivalent total dose below the tolerance of the brachial plexus. The preceding immunotherapy is not known to change the risk of radiation-induced brachial plexopathy. Contrary to popu...
What is the risk that primary prostate radiotherapy will exacerbate levator syndrome or other chronic pelvic pain syndromes?
Presumably, dose to the levator ani would matter in this situation. One paper from U. of Groningen showed that V40 for levator ani was associated with increased stool frequency. There was no metric associated with rectal pain. However, it's an entirely different question for patients with preexistin...
How do you clearly communicate to parents that the main purpose of a phase I trial is to find the best dose of a new drug with the fewest side effects rather than treating the patient's cancer?
Just with any communication, check first to see what their understanding is. Then, see if they are ready to hear what you have to say. Say it and then have them repeat it. When discussing trials, this conversation occurs over more than once. At the first conversation, one may be trying to lay out op...
Which modality of RT is most appropriate for a patient with pT3N0(sn) endometrial cancer?
For T3b, I favor EBRT plus brachy as to target disease extending to parametria or vagina. For T3a with isolated adnexal involvement and favorable intrauterine factor, she would get chemotherapy for stage IIIA disease. In the past I used to offer EBRT after chemotherapy but now, if the patient is su...