Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient needing PMRT with a history of severe burn to the chest?
In these cases, its important to consider risk and benefit. I would also discuss with the plastic surgeon with respect to skin flap. If the patient has advanced disease, I would offer PMRT, but counsel patient on increased toxicity risk and risk of infection. I would try to quantify improvement in l...
What is the effect of IV contrast on dosimetry for thoracic RT planning?
The requirement for a non-contrast CT or manual region overrides of HU prior to calculation for lung IMRT was the subject of much debate when I came to Wash U. So, we ran a simple prospective trial where we scanned 8 patients with and without contrast.Intuitively, contrast scans provided better targ...
What dose constraint do you use for the ostomy site when treating a patient with close/adjacent disease?
I treat it the same as the GI tract structure that it is part of, typically either the jejunum or colon.
What rectal dose constraints do you use for definitive chemoradiation for vulvar/vaginal cancer?
The anorectum can be difficult to constrain when treating vulvar cancer definitively, as the reason we are often treating with chemoRT as opposed to upfront surgery is because the tumor is located in or near the anal sphincter. For definitive treatment, I cover the primary tumor to 64Gy in 32 fracti...
Do you routinely order a thoracic or brachial plexus MRI for patients with apical lung cancers?
For patients with superior sulcus tumors (or apical lung tumors), their clinical presentation usually drives the choices of imaging modality. In my experience, if a patient has an apical tumor and presents with no symptoms at all, then I would not see the utility or need to require MRI imaging, unle...
When a patient presents with 2 lung lesions, do you routinely recommend a biopsy of both lung lesions?
2nd lesion may be a satellite met.
How would you manage a superior sulcus tumor following 45Gy induction chemoradiotherapy then resection that left gross residual disease in the bony spine?
This is exactly why I NEVER do this. If the surgeon feels that an operation is essential, I’d prefer maximally debunking surgery with extensive clipping of involved regions followed by chemo-radiotherapy. This has been my strategy for many years, including Moffitt and MD Anderson. We have published ...
What are the indications for radiation after cord stripping for early-stage glottic cancers?
Not sure I understand the question to be honest. Regardless, vocal cord stripping is not a common procedure these days. My surgical colleagues say it is only used for benign epithelial lesions (eg. polyps). And a quick PubMed search for "vocal cord stripping" shows studies dating back to 1945! I've ...
How would you approach the treatment of isolated lesions within the spleen for a patient with metastatic small cell lung cancer and well-controlled disease elsewhere after chemotherapy?
While it may be tempting to consider SBRT for this oligoresidual case, there really isn’t a lot of data to support such a strategy. Extensive stage small cell has a poor prognosis, and the roles of pci and consolidative thoracic RT have camps of believers and non-believers. RTOG 0937 was a consolid...
How do you think through the various treatment options for patients with unfavorable intermediate risk prostate cancer?
The first thing I do is make sure that I have plenty of time blocked off for this consultation, because these tend to be long encounters, and may require follow-up visits and/or phone calls to address all of the patient's questions. I think these are the most complex of all GU consults. The next thi...