Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When starting HN radiation, which start day do you prefer to add most value to the treatment course?
Not sure there is really strong data on the preferred day to start. With a 35 conventional fraction HN plan, starting on a Monday ends on a Friday (assuming no holidays or missed treatments). With the same assumptions, starting on a Tuesday ends on a Monday, etc. So personally, haven't been dogmatic...
What is the role for molecular agents alone for medically inoperable NSCLC who is not a good candidate for chemoRT?
If medically inoperable and deemed not a chemo candidate, my preference would be definitive RT alone using a hypofractionated approach to account for the absence of radiosensitizing chemotherapy even for patients with targetable driver mutations. The best data we currently have would then say to con...
For patients with peritoneal carcinomatosis and minimal response to neoadjuvant chemotherapy, is there a benefit to palliative cytoreductive surgery followed by whole abdominal radiotherapy?
The prognosis for individuals with peritoneal carcinomatosis is generally bleak. Administering radiation therapy to manage gastric, colon, or appendiceal cancer is exceptionally challenging due to the imperative to safeguard the delicate large and small intestine. One potential exception arises when...
Would you order a DEXA scan for a cervical cancer patient with osteoporosis?
This is a great question and one that we should all be contemplating. I do order Dexa scans on all of my post-menopausal patients if they have not had a current baseline. Many of them have lifestyle issues that could also have decreased bone density such as low weight, tobacco and alcohol use, etc. ...
How do you approach SBRT and constraining healthy liver for a small liver?
Unfortunately, there is no simple answer to this question. Someone with 700 cc of liver could be doing quite well or on the verge of (or in) liver failure. If their liver function is poor and they only have 700 cc of liver, there is a better chance that you will hurt the person by treating them with...
How do you balance the need for wound healing and time to treatment initiation in head and neck cancer patients who require a second operation?
Avoid situations where you need a second operation, do the second operation after RT if possible, or do the second operation and start RT within 4 to 6 weeks and accept a higher likelihood of recurrence.
Should we be shrinking rectal cancer fields?
I think this is a good point. However, I think we need to consider the nuances of the question. First PROSPECT included: patients that "had cT2N+, cT3N-, cT3N+ rectal cancers deemed appropriate for neoadjuvant therapy prior to low anterior resection with TME. Patients with distal, T4 tumors, threate...
Does the risk of bowel complications change in a case where there is bowel invasion in a non functioning portion of sigmoid after diversion in a gynecologic malignancy getting CRT + brachy?
The type of bowel complications would define the risk of being symptomatic. Diversion will help with the future risk of fistula but the patient can still develop symptomatic necrosis. That being said, I would prioritize cure in this situation as persistent disease would cause more symptoms.
Do you ever treat a recurrent breast cancer with RNI alone rather than chest wall and RNI?
As this is a de novo case and not a recurrence, it would be reasonable to treat the nodes and leave the chest wall alone given the small size, absence of LVI, and adequate margins.
How do you approach an elderly patient (~80 years) with stage IIC melanoma post resection with oligometastatic brain lesion post intracranial resection which developed 2 years after treatment?
If I am understanding this correctly, then all known metastatic recurrence has been resected.In that case, I recommend cyberknife/SRS to the surgical cavity followed by single agent anti-PD1 therapy. Concurrent administration of anti-PD1 with SRS or GKRS is experimental at this point. There is no co...