Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you treat neck nodes electively in transglottic/bulky T2N0 laryngeal cancers?
Generally no, but if (in particular the supraglottic) extension is significant beyond the glottis, I might give it consideration. In general nodal recurrence rates for t2 glottic is low (~5%); granted not all t2 glottic tumors have extension beyond the glottis, so the incidence may be higher for tho...
Should I decline to treat a patient with a first site of metastasis who refuses a biopsy?
Ideally, all patients with a first site of metastatic disease should have a biopsy. However, the details are critical. Is the location amenable to a bx? Is the patient's performance status poor? Has it been an extended period of time since treatment for the primary disease? Is it a solitary metastas...
In SBRT for lung tumors, does Monte Carlo dose calculation algorithm versus AAA dose calculation give a better representation of lung target dose and normal tissue dose?
I am not a physicist, and they are much better suited to answering this question than I am, but I like physics and I'm willing to take a stab at it. Monte Carlo is the gold standard for dose calculation. There is nothing better aside from other Monte Carlo alogrithms. When I first heard the terms I ...
Is social media useful for radiation oncologists?
Social media are digital communications tools which can magnify the good or harm we can do as doctors. Currently, there are many important conversations taking place online about cancer care. If we want our field to be valued and to make a contribution to the future direction of oncology, we have to...
How do you best palliate metastatic skin and subcutaneous melanoma lesions?
As with most palliative radiotherapy, hypofractionation is appropriate for most melanoma metastases in the skin and subcutaneous tissues. When giving palliative radiotherapy to the skin, it is important to be cognizant of the area of skin being irradiated, and underlying organs at risk. Small areas ...
Has pelvic MRI replaced EUS as the standard of care for rectal cancer staging?
I think looking at data both show very similar sensitivity and specificity for staging and is matter of expertise and resources available at the institution.
For rectal cancer with solitary liver metastasis, do you recommend neoadjuvant chemoradiation?
If the patient is being managed with curative intent (i.e. there is a plan for surgical resection of both the rectal and liver tumors), then preoperative pelvic chemoRT is reasonable for the same reasons it's indicated in the non-metastatic setting. This is a scenario where we often entertain short-...
Is IMRT preferred over 3D conformal RT for lymphoma of the head and neck?
If, based on the location of the node, we can spare the parotid gland more then we would do. The dose response curve for parotid salivary function is sigmoidal and not an all or none phenomenon, which is to say that the mean dose of 15Gy better than 25Gy which is better than 35Gy. As these patients ...
What type of IGRT do you use for external beam partial breast irradiation?
Cone beam CT verification if available.
For patients with high risk prostate cancer, is there data to support increased morbidity, such as increased urethral strictures or cystitis, when given postprostatectomy XRT as opposed to definitive XRT?
This is a very relevant question that commonly comes up in practice - should a man with high risk prostate cancer have a prostatectomy, when the chance of him needing post-op RT is reasonably high, if he could have RT/ADT only and possibly avoid the risks associated with surgery? The discussion must...