Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer adjuvant radiotherapy for pancreatic adenocarcinoma following surgical resection?
Unfortunately, the data on adjuvant radiation therapy is not answered. Most of the randomized studies (such as the flawed ESPAC study) do not show a definite advantage to RT (or even a disadvantage), and the non-controlled studies tend to be positive. There are a few things that we can say with some...
How do you approach a solitary pelvic nodal recurrence following definitive radiation therapy to the prostate/SV?
Briefly, I agree with @Dr. First Last and I occassionally offer treatment to solitary nodal disease, most commonly seen in the postprostatectomy, post-salvage RT setting. I'm generally not offering SBRT to nodal disease, since I think of the nodal basin needing RT (like 45 Gy with SIB to nodal disea...
What is your approach for post-implant dosimetry when utilizing a focal LDR prostate implant for salvage after a localized primary LDR brachytherapy failure?
We have recently done a few patients with LDR brachy after primary EBRT failure. MRI showed disease localized to one lobe and thus we implanted half of prostate. The d90 for implanted region we aimed for was 100% but two precautions we took were: one avoid bladder neck region and second use space OA...
Do you recommend imaging surveillance vs adjuvant RT for a large low grade sarcoma of the lower extremity with multiple positive margins?
I would recommend evaluation for re-resection to get negative margins. I would also make sure the pathology is reviewed by an experienced sarcoma pathologist, to confirm the type of histology and the grade.For low-grade sarcomas (not desmoids, dermatofibromas) in cases where re-resection isn't possi...
Would you give post operative radiation for a pT1N0 parotid low grade mucoepidermoid carcinoma with positive margin on the facial nerve to an adolescent?
Yes. Unfortunately, while the risk of second malignancy is not insignificant in an adolescent, the risk of recurrence on the facial nerve margins is expected to be quite high. Recurrence in the future along the nerve would most likely lead to sacrifice of the nerve and the need for adjuvant RT.
When is it appropriate to recommend a diverting colostomy for treatment of anal cancer or low lying rectal cancer?
If there is bowel obstruction/ near obstruction, recto-vaginal or rectovesical fistula formation.
What dose constraint do you use for the brainstem for repeat cranial irradiation?
This depends on the disease I am treating, the interval time from initial radiation, prior radiation dose and fractionation. and whether or not I am re-irradiating by fractionated or radiosurgery. If this is a recurrent high grade glioma such that the brainstem was previously treated up to 54 to 60 ...
Is there evidence to suggest that SRS/SBRT for spine or bone metastases provides faster and more durable palliative relief or soft tissue decompression than a fractionated course?
This question has two components. One is faster pain relief from spine metastasis, and the other is epidural tumor control from SRS/SBRT over EBRT. The answer is yes, but there has been no direct comparison. RTOG 0631 asked similar question, and is closed meeting the accrual, waiting for the results...
How do you interpret and utilize PSA values in patients on dialysis?
There appears to be no clinically relevant impact on total serum PSA, whereas free PSA and % of total can be impacted in a membrane type-dependent manner to where % free PSA is of less utility for screening. Thus, total serum PSA seems reasonable to continue as marker of biochemical control post-tre...
Would you recommend post-operative radiation to an oligometastatic subcutaneous lesion resected with positive microscopic margins?
Probably not. I would need to know more specific details on the situation before making a recommendation.